It's a death spiral. Companies will continue to hike their rates and reduce coverage, so fewer people will get health insurance, so companies will have to further hike their rates and reduce coverage, until the whole system collapses.

What Snoopy said. Then we can go single payer and enjoy government run health care, like they have over at the VA.

Oh.

It's just a complete failure of all parties to think. Why should you pay for anything you do not get?

Why, because government is promising to take care of me!

They can't. Embrace the bitter truth.

And suggest a solution.

I know you don't like Trump, Amy, but if Clinton wins, Obamacare is here to stay.

When the president rammed his partisan health care law through Congress...

This is one bit of the law that still pisses me off to this day, and that so few seem to know or at least remember. It's even in the wikipedia pages on the ACA, but the senate took an unrelated bill, basically completely replaced it with their version of the ACA and passed that (through shady means even) so they could say, "But this bill started in the house!" Then they used more shady dealing and tricks (reconciliation anyone?) to get around a filibuster in the house as well.

Even with majorities the Dems couldn't pass the damn thing in any kind of straight-forward manner. But people are only against it because Obama is black.. or something.

Don't forget about the Cornhusker Kickback and the Louisiana Purchase... deals in which certain states were promised special privileges under Obamacare in order to woo votes from their delegations. (Most of it turned out to have been double-cross; the promises were promptly forgotten as soon as the votes were counted.)

Health insurance: my proposal:

1. Make all medical expenses and insurance tax deductible. Kill some other deductions to compensate. I suggest putting caps on the mortgage tax deduction, so it is no longer an incentive for the very rich to buy ridiculously bloated mansions, nor for the upper middle class to buy more house than they can afford and call it an investment. That is, I would limit this deduction both in absolute amount and as a percentage of income.

2. As the main means of deducting medical expenses, make _everyone_ eligible for HSAs, whether or not they have insurance or an employer. Just like now, what you put into the HSA is non-taxable, as is any interest it earns. You can pay for your insurance through an HSA, as well as for all medical and dental treatments, devices, and drugs. Change the annual limit on contributions per individual to $5,000 plus all expenses paid through it - that is, encourage people to build up tax free savings in their HSA while they can afford more than they are spending.

3. Insurance should be separate from employment.

4. Insurance should actually be _insurance_. That is, it should pay off only on large expenses due to unexpected events. You use the HSA for routine stuff. You should never lose coverage because of illness, even when the expenses go on for years. (Unlike the current so-called insurance plans, which are sometimes comparable to a fire insurance policy that only pays for rebuilding your house if you can get it done before they can cancel it at contract renewal time.) Get a serious condition that is only treatable, not curable, and your insurance company can neither get you off the books nor raise your rates.

5. Insurance must be portable between states. You change jobs and move to another state, and you have the option of taking your insurance with you. If they don't have "in network" providers in your new area, including any specialists you need, they'll have to treat all the providers as "in network". Insurance companies will have one out - they can negotiate with other insurers to transfer your policy to one with a better local presence, but coverage must be as good or better, and the premiums can go up only to the extent that the federal plan ("CrappyCare", see below) rates the new location as a higher cost area.

6. Finally, what happens when the uninsured get sick (and don't have enough in their HSA and bank accounts), and what happens to people that never make enough to cover their medical expenses? We'll provide for them, but not generously:

7. Emergency rooms are still required to provide care for anyone brought in with a medical emergency. Hey, if someone conks you over the head and steals your wallet, you want to be cared for until you wake up and can tell them how you're going to pay. But they are no longer providing free care for the indigent and irresponsible, and no longer allowed to inflate the paying customers' bills to make up for the deadbeats. Instead, unpaid charges can be sold to the IRS for collection, at a 10% discount. (Preferably this is tied to a tax code simplification, so the IRS can transfer staff rather than expand.) There are limits on the amount, and an appropriation to cover those debts that cannot be collected, but lets make it quite clear that misusing an emergency room for a "free" visit to the doctor's office is going to cost you.

8. The ultimate fallback: CrappyCare (the federal healthplan, like an expanded Medicaid). Politicians will make a nicer name for it, but let's be honest in these pages: government insurance either busts the budget by allowing providers to raise their rates and "do everything possible", or it is crappy. Everyone is eligible, but there is a means-tested premium; it's only free for the very poor. You can pay from an HSA or with a checkoff on your income tax return. Pre-existing conditions are covered, and you can even sign up in the emergency room and have that and other recent expenses covered, but if you were uninsured before, you owe premiums for the last three years. Once again, if you need treatment now, you get it (whatever CrappyCare will pay for), and can pay later, but you do have to pay it and the IRS is the debt collector.

"Gov. Jerry Brown on Friday signed a bill into law authorizing the waiver application that, if granted, would allow currently ineligible undocumented immigrants to purchase their own coverage on the state-run health care exchange, Covered California."

Obamacare: even when you're paying for it you're just getting started paying for it.