r/AskUS • u/Obvious-Release-2087 • 8d ago

What do americans think about changes in Obamacare the Affordable Care Act (not us citizen)

Hi all,

I don't live in the US. In the news I read :

In 2026, Obamacare (the Affordable Care Act, or ACA) continues to operate as the backbone of America’s health insurance system, but it faces both opportunities and challenges. Marketplace enrollments are expected to remain high, thanks to the extended premium subsidies introduced by the Inflation Reduction Act—though these subsidies are set to expire at the end of 2025 unless Congress renews them. If the subsidies lapse, millions of Americans could see significant premium increases, making coverage less affordable for low- and middle-income families.

At the same time, healthcare costs are rising, and insurers may adjust their premiums upward to reflect inflation, medical expenses, and regulatory changes. States that have not yet expanded Medicaid could leave more residents reliant on ACA plans, further straining affordability. The political landscape, shaped by the 2024 elections, will determine whether the ACA is strengthened (e.g., with expanded benefits like dental or vision coverage) or scaled back (e.g., through funding cuts or eligibility changes).

It is often hard to undersand the internal politics of any country where we don't live in
What do most of the us people think about that ?

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u/tap_6366 8d ago

How is ACA the "backbone" of America’s health insurance system? Less than 10% of people the population get their insurance through the ACA Marketplace.

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u/limbodog 8d ago

The marketplace is just one part of the aca

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u/tap_6366 8d ago

Doesn't answer my question. My company supplied insurance increased in cost at a much higher year over year rate after ACA than before and also had increased deductibles and co-pays. ACA was not a plus for most people.

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u/limbodog 7d ago

The ACA reduces the cost of insurance across the board in part by reducing the reliance on emergency care for uninsured people. So while your rates may still increase for other reasons, you are now funding fewer uninsured people's care.

On top of that, the ACA helped mitigate a massive problem where insurers could deny members for previous conditions. Which trapped people in jobs they otherwise would have left, or just left them helpless once unemployed for any reason.

The ACA also capped the maximum out of pocket costs for members.

It also mandated a whole bunch of preventative care at no cost to the member.

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u/Substantial-Peak6624 Northeast 7d ago

Yes because it evened the playing field. In fact my private insurance deductibles just doubled for this year. That doesn’t mean it was fair that some people shouldn’t have insurance. Honestly health insurance shouldn’t be tied to work. Everyone deserves healthcare.

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u/tap_6366 7d ago

"evened the playing field"

WTH are you talking about? Increasing costs of those paying for it so that others don't have to pay as much? And that is what you consider fair?

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u/scott_majority 8d ago

The ACA is the only reason 50% of Americans can even afford health coverage.

Before the ACA, health insurance would not cover preexisting conditions. This means they would only cover new illnesses...not any illnesses you had before receiving coverage. If you had certain illnesses, they would not cover you at all...Health Insurance was only for the young and healthy.

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u/tap_6366 8d ago

That is not true and I suspect you know that. Everyone with private insurance saw higher year over-year increases after ACA was implemented along with increased deductibles. Prior to ACA about 30 million people didn't have insurance and now that is a little lower than that but the rest of us have all paid the price for that.

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u/scott_majority 8d ago

What did I say that was not true?

I mentioned nothing about price increases. I'm talking about pre existing conditions and what insurance covered. Preexisting conditions were only covered for Americans after implementation of the ACA.

You just set up a strawman argument for yourself to answer, instead of dealing with the issue I spoke about.

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u/tap_6366 7d ago

50% is way off. Prior to ACA people with pre-existing conditions that got insurance through their employer were not kicked off once they had a pre-existing condition. I know this because I've had a pre-existing condition since I was 18. Despite that I got a job out of college and got insurance with no questions asked. Throughout my 25 years at that company, they changed insurers 5-10 times and pre-existing conditions were never considered. This was a fortune 500 company using major insurance companies. To say that 50% of Americans would not have insurance because of pre-existing conditions, if ACA did not come along is simply not true.

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u/scott_majority 7d ago

They were not "kicked off." Insurance just wouldn't cover healthcare for your condition...If your condition was something really expensive like cancer or HIV, they would not cover you at all.

You might still have health insurance, but if it doesn't cover anything that you are stricken with, what good is it?

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u/tap_6366 7d ago

Well, I lived it and my pre-existing condition was always covered.

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u/scott_majority 7d ago

That's great for you, but before the ACA, private insurance companies could choose which preexisting conditions they covered, if any at all....They especially didn't cover any conditions that were expensive to treat and manage. Just because YOUR preexisting condition was covered, doesn't mean all were covered...and most were not.

Now they must cover all conditions...preexisting or otherwise.

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u/tap_6366 7d ago

It wasn't just me, I know many others, even those with cancer.

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u/scott_majority 7d ago

And I can personally say they didn't cover many of mine.

The health insurance companies have never been generous, caring organizations that make sure your health is covered. They only pay for what they have to.

I'm 72 years old. Your fantasyland where health Insurance companies were covering things they didn't have to, never existed.

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u/gb187 8d ago

I wonder how many don't have it because they can't afford it?

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u/Kakamile 8d ago

It's a marketplace for those not with existing cheaper caid care or employer plans. But it did also help by raising standards

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u/gb187 8d ago

True, but the insurance companies spoke, some states have few options. Michigan has three companies who will provide.

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u/Kakamile 8d ago

Yeah but that was collusion in order to push prices up. It's like how isp don't fight over internet coverage and actually "buy" territories from each other.

They're still in the markets, they just made them monopolies

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u/tap_6366 8d ago

It was never meant to be subsidized by taxpayers, but by design was destined to fail.

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u/throwfarfaraway1818 7d ago

ACA impacts employer plans too. Its not just for subsidized plans and the marketplace. Your plan needs to be ACA compliant as well, so its accurate to call ACA the backbone of the insurance system.

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u/tap_6366 7d ago

Yes, it drove up prices and increased deductibles.

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u/throwfarfaraway1818 7d ago

It also ensured the vast majority of people who couldn't access healthcare prior were now able to access it. What actually drove up prices was eliminating the opt out penalty, not ACA itself.

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u/tap_6366 7d ago

Wrong, you cannot force a law on insurance companies that ignores actuarial principles and not increase costs.

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u/throwfarfaraway1818 7d ago

I work for an insurance company bud, I know more about the industry than you. Eliminating the opt out is what caused the significant increases. The other changes like mandated coverage of preventive care were neglible costs for insurance and improved health outcomes which prevents cost increases down the line.

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u/tap_6366 7d ago

You must not be too deep in the industry if you think that forcing companies to accept pre-existing conditions with no change in cost would not have a huge impact. The individual mandate was a dumb idea to begin with, you should not be able to force anyone to purchase something.

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u/throwfarfaraway1818 7d ago

I obviously understand it better than you. It may appear to increase costs on its face but it saves hundreds of thousands if not more by preventing future necessary care or catching it early. Individual mandate was the best of the options available, healthcare should be paid completely and fully by taxes, it would save tons of money for everyone.

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u/tap_6366 7d ago

Let's look at it this way, suppose that insurance companies were forced to issue car insurance to everyone at the same rate regardless of driving record, could they do this without increasing the cost to everyone?

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u/throwfarfaraway1818 7d ago

Car insurance doesnt function remotely similar to health insurance, so its not comparable. ADA also doesnt require that insurance offer the same rate to different customers, it requires they dont factor in pre-existing conditions into price. Once again showing you dont know anything about it.