This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before).
So I guess I'm on a primary care physician merry go round :D
I am at least able to have my main specialty doctor and the drug I take to keep me in remission from Crohn's disease, and my kids' pediatrician is covered.
But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :("
These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020.
The enhanced subsidizes made it so people earning more than 400% FPL were also eligible for subsidies, but also more importantly increased the cap on how much income insurance could cost. In reality, most people would see their insurance costs double if the subsidys expired [1].
[1] https://www.kff.org/affordable-care-act/aca-marketplace-prem...
(It's getting late, Jeff. I'm heading to bed myself.)
https://www.jeffgeerling.com/about
He is impressive.
I'm probably going to be self employed for 2026 and a cheap-ish (not the cheapest, but probably below the average) plan for my family is going to be a little under $1500 / month.
It's pre-tax money, which helps a wee bit, but it is definitely expensive. If I made less money, I'd qualify for subsidies, but I don't, so that's just something that needs to be paid in full unfortunately.
I’m in Germany, and for a family of four, the public healthcare system, covering my wife and my two kids costs us around 2,200€ per month. The company pays half.
A switch to a private insurance would lower the costs around half.
Brutal.
Meanwhile the White House calls it all "fake news".
I feel like we need a perpetual PSA here that moving money from person A to person B obviously doesn't make anything cheaper.
No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal.
https://www.cnbc.com/2025/10/17/aca-enhanced-subsidy-lapse-g...
I don't want my tax dollars wasted on subsidizing them. Give the money to someone who actually needs it.
(Of course the real problem is healthcare costs accelerating out of control. Insurance subsidies won't fix that problem. In fact they make it worse by encouraging healthcare providers and drug companies to raise prices even faster.)
These are legitimate complaints. Trashing the system because it's overly generous in some respects is insane.
> Give the money to someone who actually needs it.
Like billionaires. They are the ones that really need it, and they get it; every time. Those yachts don’t pay for themselves.
If anyone thinks poors will be getting any help, they are fooling themselves. Helping poor people is quite unpopular, in the US (where they conveniently forget that most of them are born in the US white, but politicians make it seem as if they are all dark-skinned immigrants). Many of the hardest-hit states will be ones that enthusiastically voted for this.
Now, you have a lot more angry people, and hopefully that leads to real reform, because what we have now is unsustainable, even to upper middle class families.
The underlying issue is inflation adjusted healthcare related spending increased 6x per person since 1970. Some of that is an increase in quality, but middleman are a huge factor.
B) Biden papered over A) with "temporary" covid subsidies in 2021 and those are going away, revealing A) again
It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.
One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.
Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
(And I'm not an expert so hopefully people will correct any mistakes)
"Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse.
On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.
> Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.
This month is when all hell breaks loose, because people will get their first invoice at the new rate. They already know how much, but seeing it in the form of a demand, will drive it home.
Obamacare is like the NHS, in the UK. Everyone likes to bitch about it, but woe unto the politician that messes with it.
Talking about all hell breaking loose... Marjorie Taylor Greene announces her resignation specifically because of rising health care costs (yeah, I'm cynical,there's maybe more to it). Mamdani gets elected on a platform that's essentially "shit costs too much." Maybe folks on both sides are starting to wake up. A guy can dream...
Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed?
In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total?
Since premiums never decrease, one can pretty easily plot out that in the next ~decade we will see family premiums larger than the median salary. The economics of all this are going to get very weird in the near future.
Is there a rich caste of doctors or pharmaceutical shareholders that don't need to work and live off these dividends? Or is the system so inefficient that most people in it aren't contributing to actual health care?
Can you be health insured outside of the country you live?
Health insurance premiums cost about as much as buying a new car every year. Healthcare is generally on top of those premium payments.
To see the actual costs for yourself, go to healthcare.gov. The “bronze” plans are the ones with high deductibles. If you’re young and healthy, a high-deductible plan combined with an HSA is a very good idea.
On the other hand you provided no details as to where the money actually goes. It's not a simple proble, and part of the problem is that our doctors are paid a lot more than in peer nations
https://www.researchgate.net/figure/Healthcare-administrator...
"Healthcare administrator's growth in the US. Healthcare administrator's growth by 3200% between 1975 and 2010 compared to 150% Physician growth according to Athena Health analysis of data from Bureau of Labor Statistics, the National Center of Health Statistics, and the United States Census Bureau's Current Population survey in accordance to [26]. Admin: administration; HIPAA: Health Insurance Portability and Accountability Act; HITECH Act: Health Information Technology for Economic and Clinical Health Act; DRGs: diagnosis-related group's."
The only class of medical services that has become more affordable over the last 50 years is cosmetic procedures and laser eye surgery:
https://healthblog.ncpathinktank.org/why-cant-the-market-for...
What could go wrong putting a bunch of finance bros at the wheel of a "Pay this amount or suffer/die" industry?
It's nearly impossible to buy a legitimate low premium high deductible plan now.
The end result is we all have Cadillac plans that most people don't need.
That’s a meaningless statement, look for an actual percentage here.
Healthcare costs have been spiraling for decades in the US, the ACA didn’t impact the long term trends to a noticeable degree. Actual healthcare reform could drive down costs massively, but that would mean a fuck load of people in medical billing getting laid off. Instead you’re paying for your doctor to talk with your insurance provider often for longer than they spend working with you, that’s the ultimate issue with US healthcare costs. Inflation adjusted “healthcare” spending is up from 2,100$/person in 1970 to 14,570 in 2023.
https://www.healthsystemtracker.org/chart-collection/u-s-spe...
Annual check ups? Cancer screenings? Maternity care? Basic mental health? Forcing the insurance companies to accept patients with preexisting conditions?
These services should be available to everyone.
If a developed country cannot provide these things to its citizens it's a failing state in my book.
Now whether the on-paper prices for medical care in this country actually have any relationship to objective reality is an entirely separate question of course. In general coming from an outside perspective, combining healthcare and for-profit motives in a single system seems particularly likely to lead to all kinds of perverse incentives, but, it's the system that exists, and it seems unlikely to change any time soon.
If young people elected to get a barebones plan while in good health, who would subsidize them when they grow older?
Obamacare plans are actually the opposite: they are high deductible with limited networks.
Obamacare plans typically have deductibles between $5,000 to $9,000, with a narrow selection of networks, and high premiums if unsubsidized.
This is the opposite of what a a Cadillac plan is (or used to be).
Do you have data that shows this is the case?
That's right, those pesky things the ACA says should be covered like emergency services, ambulances and prescription drugs is definitely the issue here. You've definitely found the problem.
I can't believe people keep repeating this lie. Did no one live prior to the ACA where you could easily go bankrupt because your insurance decided it didn't cover things like hospital bills? Because I sure as fuck remember, considering that's what bankrupted my parents.
If you don’t you pay a lot. Before ACA non-group plans generally didn’t cover any health conditions that predated your coverage.
ACA was just good enough to cool down demands for a true public health plan while also being just shitty enough to turn everyone else off to ever wanting one. Essentially the perfect way to prevent a public option for generations.
Reads a bit like you’re in a bubble. I have friends in the States who work in education, construction, and hospitality. I similarly have friends working in those fields in EU. I’d say the ones in EU are better off _and_ don’t worry about healthcare.
Not to mention you get actual vacation time in Europe and a higher standard of living generally.