Quote of the Day
Democrats are looking ahead with hope that the anger in their party boils over so they can focus on hammering Republicans over health care. Next month, Republicans will give Democrats a vote on extending the enhanced ACA subsidies. It will almost certainly fail, and Republicans are preparing an alternative plan they can put on the floor to vote for instead. Nevertheless, it will give Democrats another opportunity to go on offense.
Sen. Brian Schatz (D-Hawaii) said while it’s “definitely a disappointment” the shutdown didn’t end with the outcome Democrats preferred, people should be directing their anger at those imposing higher health care costs on Americans.
Igor Bobic, Jennifer Bendery, and Arthur Delaney
November 11, 2025
Why Democrats Caved In The Shutdown Fight | HuffPost Latest News
What I don’t see discussed in the media in plain language is the consequences of these higher premiums. Except for U.S. New & World Report, the wording is all, at best, very circumspect:
5 Consequences If ACA Premium Subsidies End in 2026 | AJMC
The return of the subsidy cliff would likely lead to “coverage churn,” where individuals cycle in and out of insurance due to fluctuating income. This instability not only undermines continuity of care but also disrupts the broader insurance market by reducing the number of healthy, continuously insured individuals.
What expiring ACA subsidies could mean for consumers and the economy | Mizuho Insights
In the absence of subsidies, the U.S. healthcare system will confront lower volumes, tighter margins, and renewed financial pressure across the board. For a sector already navigating demographic shifts, labor shortages, and cost inflation, the withdrawal of federal support could prove a defining headwind in the years ahead.
What the End of Obamacare Subsidies Could Mean for Your Health Coverage | TIME
Insurers across the market—not just those relying on ACA subsidies—are bracing for the effects of the expiration, as volatility is expected.
The shutdown is about to end. Will millions lose their health insurance?
Without the pandemic-era subsidies, ACA health insurers could face the prospect of serving a larger share of high-cost enrollees, Corlette said.
“We could be in for a stretch where insurance companies have to raise their premiums again to reflect a smaller and sicker market,” Corlette said. “So 2027 premiums are likely to be even higher, and some insurance companies may decide this is not a market they want to continue being in.”
Hospitals Face a ‘Slow Train Wreck’ if ACA Subsidies End, Expert Warns | Health Care | U.S. News
Could the loss of these subsidies destabilize insurance markets, and if so, what kind of consequences could we see for patients and for providers?
We already know that insurance companies are bracing for a market that is much smaller, has fewer enrollees but is also much sicker than it has been.
That’s because insurance companies are assuming that the people most likely to be deterred by a higher premium are folks who are relatively young and healthy. What insurers really need is what they call a balanced risk pool, where there’s essentially a balance between healthy and sick people, with healthier people subsidizing sicker folks. Then the healthy people drop out, which means that the insurance companies have a smaller group of more expensive people to cover and then they raise their premiums.
Some of them may find the market less attractive because they worry they can’t fully recoup their costs. So we could see over time, not only rising premiums in this market but also fewer insurance companies participating.
Let me translate this for you. With the subsidies ending there is a high risk of a death spiral in the health insurance industry. As premiums rise, healthier enrollees are likely to drop coverage, leaving insurers with a sicker, costlier pool. This forces insurers to raise rates further, compounding “instability.”
Copilot supplied:
Bottom Line
The end of ACA subsidies would mean higher premiums, fewer enrollees, and greater instability for insurers, while threatening the ACA’s long-term viability. Unless Congress extends or replaces subsidies, the ACA could face a slow-motion collapse driven by adverse selection and affordability crises.
The insurance companies will have to revert to some of the previous practices which protected them against this sort of death spiral insurance premium situation. They will need to be able to refuse insurance to people with preexisting conditions. While unpopular, they may revert to having lifetime and annual limits which were banned by Obama Care.
As near as I can tell, the U.S. Constitution does not give the U.S. Government the power to provide health insurance. Of course, during the Obama administration SCOTUS disagreed with my reading of the U.S. Constitution.
My take on this is that the money has to come from some place. The subsidies are paid by taxes. By cycling the money through the tax process, then back to insurance companies, then to healthcare providers a considerable amount of “friction” has been introduced, and the total cost of health care has been increased. This is a waste of money.
Free markets are best because they reduce “friction” and the competition results in innovation.
Let ACA fail. Let people evaluate their own risks and be responsible for their own health care. Let insurance companies tailor their coverage for the markets and how they decide to define them. Let private charity groups vet and pay for deserving people unable to afford insurance or pay out of pocket. Let the people who chose to abuse their bodies with consumption of alcohol, tobacco, other recreational drugs, and other risky behaviors pay the price for their stupidity.
Prepare appropriately for the transitions.
In its first ruling, the Supreme Court didn’t rule the ACA was constitutional, it ruled it was a tax and the government has the authority to tax.I haven’t followed any follow on rulings, if there are any.
More specifically, they decided the penalty for non-compliance with the mandate — that every person must purchase health insurance — falls under Congress’ authority to tax. The mandate and penalty are critical to the viability of the ACA as a whole.
IANAL, but that’s a stretch, and not just because taxes (which should apply to everyone) and penalties (which only apply to people in non-compliance with a law or regulation) are not the same thing. Justice Thomas said in his dissent that the Court’s #1 priority seemed to be that the ACA must survive. Without that mandate and penalty, the ACA is meaningless, so for the ACA to survive, the mandate and penalty must be found Constitutional.
And so the Court DID find it Constitutional … under an Article I power that neither oral arguments nor (AFAIK) amicus briefs ever mentioned … and despite taxes and penalties being two different things.
(IANAL, but if neither the ACA’s supporters nor its opponents saw fit to frame the question in “Article I power to tax” terms, is it ethical to decide based on that framing?)
Of course, that nicely demonstrates that the anti-federalists were right when they complained the Constitution granted an unlimited power to tax, and Madison was wrong when he concocted a fanciful argument (based on a bizarre story about the punctuation of article 1 section 8) — Federalist #41.
It also demonstrates that Roberts has little or no respect for the Constitution, given that he reworded the ACA to justify that ruling.
I would like to be able to purchase health insurance just like I’m able to purchase automobile insurance.
I’d like to have a relatively high deductible since I’m able to self-insure for accidents which don’t destroy the vehicle, only damage it. I’d like my coverage to kick in when the damage exceeds some level (say, $2500 or $5000) with 100% coverage above that.
I don’t expect my auto insurance to cover wear-out items like tires, windshield wipers, batteries, carpets, or seat covers. I don’t expect my auto insurance to cover maintenance items like oil/filter changes or new brake pads. I’ll take care of my own maintenance costs; they’re not a catastrophic thing for which to pay.
The parallels to health insurance are almost exact. I want a policy with a high deductible since I can self-insure to that level. For ordinary sicknesses which require a visit to a doctor I’ll pay for it myself…and I’ll shop for a good doctor with reasonable prices, something we are not allowed to do today because of federal law. I want that policy to kick in only when the deductible has been met for some catastrophic illness, like a hospital-required accident or cancer.
I’ll take care of maintenance costs myself. Routine check-ups, ordinary minor surgeries (I’ve already had a few skin cancers removed) and other procedures that can be regarded as maintenance or preventative I’ll pay for on my own.
Why can’t I buy a policy like that today? The federal government FORBIDS insurance companies to sell them. And then they wonder why healthy people avoid the Obamacare system like (heh-heh) the plague.
Part of the issue is that “health insurance” doesn’t function like any other type of insurance. Your home and auto insurance might cover damage and catastrophic mechanical failures, but they don’t generally cover routine maintenance or damage you cause yourself through carelessness.
Health insurance does.
IMHO, one of the primary reasons healthcare coverage is so expensive is — as you point out — because it covers so much more than home or auto coverage, that it defies the normal scope of the word “insurance” (which typically means a guarantee of compensation in case of specified damage or destruction). The kind of all-encompassing, maintenance-included, we-pay-for-you-after-you-cover-a-copay monster we call “health insurance” is so unlike any other type of insurance that I dislike using that word for it.
I don’t expect my life insurance to pay to keep me alive; that’s not what it’s for. Similarly, I don’t expect my homeowner’s insurance to pay for a smoke detector batteries, HVAC filters, or new light bulbs; or my auto insurance to cover oil changes, tires, or new wiper blades. All that falls under “maintenance”, and if they did cover those things, I would understand if they charged a LOT more in premiums.
If I could get a healthcare plan that let me pay cash for routine check-ups, physicals, vaccinations (if I want them), and small boo-boos, and only kicked in for big accidents and unforeseen problems — and charged me half in premiums what I pay now — that would be more like the normal definition of “insurance” … and I’d be all over it.
FWIW, most of the doctors I’ve been to would also be on board; the amount of overhead and additional staff required to process and submit “insurance” claims — and handle or re-submit disputes and denials — is insane, as is the 3-6 month delay on reimbursement from the insurance companies. Cash-up-front is much simpler.
(Ever wonder how a diagnostic imaging office can get away with advertising a “$200 Open MRI” that your insurance would pay $1800 for? That’s how; with cash up front, the office gets paid NOW as opposed to 3-6 months from now, and doesn’t need to employ a team of claims specialists to submit — and amend and re-submit — the paperwork. The difference in the necessary overhead is mind-boggling.)
This “cover all the routine stuff, and add as much routine stuff as possible” is a deliberate play to increase healthcare costs. Insurance profits are capped as a percent of revenue, so the only way to increase profits is to increase costs. There is no money in dead people, there is no money in healthy people, so the sweet spot is chronically sick people. Pharma designs lot of treatments, but offers few cures. Then they design the allopathic medical curriculum accordingly. Vaccinate kids for free, induce a huge number of chronic health issues, treat them for life. Get everything possible covered, and take a percentage. A few years back they were lobbying to make sure sex-change surgery and drugs were covered because it guaranteed life-long customers; it was literally touted as the next big profit-growth area in “health care.”
Insurance runs the world in may ways, in that almost everything major requires insurance, so the cost of it controls the decision-making process as to what’s an “acceptable risk.”
You are interchanging “pharma” and insurance so much that I cannot distinguish which accusation you are making to which entity. Could you make this a little clearer so I can respond appropriately?
Yes. They work together. Not in a “smoke-filled room of industry titans openly conspiring” sort of way, but in a “mutually aligning and reinforcing goals, means, and methods” sort of way.
Insurance writ large has a veto-vote on a great many projects, because if you can’t insure the only way to go forward is to have such huge profits or such low risks that you can eat the losses and still operate.
Specific to health-care, insurance profits are capped as a percentage of premiums, and premiums are capped as a percentage of claims paid, so the only way they can increase profits is to increase coverage used to justify their increasing premiums. They don’t make money on healthy people who don’t use the health-care system, because they don’t justify high premiums. Money is extracted from healthy people to cover care for ill people. So they are highly motivated to do two things: lard up coverage with as many covered things as possible, and NOT pursue programs, knowledge, or policies that actually keep people healthy or reduce the costs of treatment. 5% profit on a $20 pill is much less than 5% profit on $200,000 patent treatment with a bunch of side-effects that also have to be treated.
For their part, pharma makes money when it sells expensive patent treatments, ideally for chronic conditions where the buyer has to purchase them for life. So they are highly motivated to constantly come out with new patent meds and dismiss or denigrate old ones, or come out with real cures (only symptom treatment). They are also highly motivated to NOT research side-effects (e.e., the childhood vaccine schedule cause a host of chronic health problems) or new uses for off-patent drugs. If anti-parasitics like ivermectin and fenbendazole are proven by major study to treat, say, 80% of cancers, then Big Pharma would lose tens of billions in profits in that one space.
Meanwhile, the media is highly motivated to not investigate such claims as more than half the legacy media ad revenue comes from Pharma, and congress is highly motivated to not investigate as Pharma is a MAJOR donor to every candidate from both parties.
Who puts the most into writing the med-school curriculums? Docs working for pharma so other docs will know what to prescribe where. Doctors who know what’s going on still want to get their paychecks, so they don’t rock the boat.
Most typical health-care workers can’t see it and are willfully blind to it because they don’t want to see themselves as the villain in the health-care crisis, so they don’t know because they don’t look into it with a critical eye. Stories like virtually all SIDS deaths coming shortly after routine vaccinations are not investigated or pushed even though they are factually true, because they threaten HUGE medical-industry profits.
Yeah, sure, it’s all tin-foil-hat stuff; that doesn’t mean it’s not correct. The fact that many of these claims are dismissed with handwaving and studiously NOT properly investigated should be a red flag to any thinking person.
There are at least three flaws in your reasoning.
1) You overlook another way to profit. By decreasing the cost of the product of equal value to the competitors a company can increase total sales.
2) You assume all insurance companies are profit motivated. There are non-profit health insurance companies and co-op health insurance organizations.
3) If a cheap and effective cure for cancer or any other disease were available there would be doctors someplace, in other countries, ships just outside of the territorial waters, even the black market, offering the cure and making a huge profit.
Free markets are amazing things and even in very unfree situations, such as when dealing with completely banned products, markets will find a way.
From talking to a health insurance company employee in the actuary side of the business, I was assured the company has no such “aligning and reinforcing goals” with the pharmaceutical companies. The drug portion of health care cost is significantly less than the doctor, nursing, equipment, and hospital components of health care. Copilot confirms this and says the drug component is only nine to ten percent of the total cost of health care.
I do agree with you on it being all tin-foil-hat stuff.
Why do you think the health insurance industry helps write the regulations? So they are all restricted in the same ways. It’s effectively a cartel. Alternative treatments for Covid were not just not pursued, they were actively shut down, their supporters canceled or attacked legally, etc. while the hospitals followed the official “standard of care” that killed many who went to the hospital… but also ensured they got their payola. If they didn’t follow the official “standard of care” (which they KNEW didn’t work because so many people died under it) they were also shielded from legal liability. Ivermectin worked quite well. I know many, including my own family, for whom a covid infection was a three-day nothing-burger because of it, but it was widely denigrated as “horse paste” by the establishment because it was cheap and easy. They needed to get their jabs in everyone.
Not sure why you trust copilot so much, or assume that it’s only a half-truth. Yes, drugs are only a portion of the costs and profit-centers… but if a fifty-cent pill OTC can do what ten grand in drugs and a $100k in doctors fees can do, both hospital and pharma lose massivly WRT profits even if it’s a true statement that the drugs are only a fraction of the total cost.
You are very smart, Joe, but you are missing the forest for the trees on this topic, just like gun-controllers can’t see reality of gun laws and crime. We have stupidly expensive health care AND declining general health; something isn’t right. Just look at the graphs near the beginning if you don’t have time for the whole thing.
https://rumble.com/v23e5lw-vaxxed-vs-unvaxxed-dr.-paul-thomas-and-dr.-james-lyons-weiler-put-cdc-vacci.html
You are changing the subject. Please address the nonprofit insurance companies and black/gray market points I made.
But, but, Obama promised I could keep my doctor but when ACA took effect he closed his private practice and moved to Wyoming to retire at 52 years old. I was promised a free lunch. Where’s my free lunch?
The “undocumented immigrants” ate it.
(Offered with tongue firmly in cheek; it’s not totally fair or accurate. OTOH, it’s not totally unfair or inaccurate, either.)
Millions of the people receiving the enhanced subsidies, never had a single claim. Were they extraordinarily healthy or simply non-existent. Nobody knows but the insurance companies made a bundle.
All insurance is just a “risk pool” that insurance companies take a skim off the top of.
Get the government involved and all you get is an increase in the skim and corresponding increase in premiums.
Someone has to pay for your health care.
And it’s NEVER going to be the government or insurance companies.
That’s just the reality of it.
Arguing over ending Obamacare or not, is truly an argument over who gets to steal what and how much from whom.
And has almost nothing to do with people’s health. As covid proved that system as corrupt as government ever could be.
To mention nothing of collusion, antitrust violation, and price fixing for the past 50 years in all three sectors. Never forgetting that both banking and Wall st. are nostril deep in all this also.
Maybe doctors should go back to living where they want. And excepting what that community can pay them again.
Be it cash or chickens.
I’ve never been anywhere where doctors weren’t respected and had the highest standard of living in the community they chose.
The rest is just parasitic theft.
The government getting involved with health insurance is just the same thing as the government getting involved in guaranteeing student loans. The action made the cost of going to college skyrocket, because the banks knew that they would get paid no matter what.
The colleges in turn started to have to compete for students dollars, and thus the multi million dollar student halls, intramural athletic fields, big name professors, etc.
The government needs to stay the hell out of things that they are not specifically authorized to be involved in by the constitution. Of course that is looking at a rose colored glasses utopia, and will never happen.
The left is going to LIE…long and loudly…about how ALL the misery people are suffering with is the fault of the GOP. It’s WHAT THEY DO. And it works. Because MILLIONS of voters are idiots.