2026 CMS Cuts Finalized

[TeslaCoil]

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Surprised nobody has brought this up on here yet. Another year another 2.5% cut. How is this sustainable? I mean... we cant just keep increasing productivity to compensate for this nonsense. At what point do physicians begin taking the hit? Overworked and underpaid, who would want to keep doing this?

Medicare finalizes controversial cut to specialty care next year

The CMS finalized the Medicare physician fee schedule for 2026 on Friday, one day before the statutory deadline. It includes an overall payment hike and a few policies that are deeply unpopular with specialists.

www.healthcaredive.com

 

[aneftp]

Some winners and some losers. It sucks for the losers. We get it

What’s fascinating is u can do tele health remotely while supervising a resident who is also remote and not in the same location.

“The agency will permanently allow teaching physicians to supervise residents virtually, but only when the patient, resident and supervising clinician are participating in a three-way telehealth visit. The policy applies to rural and urban area”

https://www.fiercehealthcare.com/regulatory/cms-finalizes-increased-pay-rates-physicians-2026-hospital-docs-could-lose-out

 

[Radar26]

Meanwhile facility fee reimbursement continue to rise. It’s just more argument to shift the focus of compensation from billing insurance/government to getting a bigger and bigger piece of the facility fee.

Physicians need to get more and more into owning the actual shop they work in weather it be hospital or ASC.

 

[kidthor]

Physicians need to get more and more into owning the actual shop they work in weather it be hospital or ASC.

Except that sadly the ACA makes it illegal for physicians to own hospitals!

 

[Lab Lover]

Meanwhile facility fee reimbursement continue to rise. It’s just more argument to shift the focus of compensation from billing insurance/government to getting a bigger and bigger piece of the facility fee.

Physicians need to get more and more into owning the actual shop they work in weather it be hospital or ASC.

Physician owned facilities are more efficient and profitable. But they are so because they skim the cream and cherry pick healthier patients and more profitable procedures, no emergency rooms, no sick as **** patients who require complex care.

 

[emergentmd]

Nothing to see here. The ACA was the beginning towards universal HC and will be pegged to Medicare rates. All specialists including anesthesiologist will take a 50+% haircut. I wonder how the leftist docs on here will think when their salary drops by 50%.

 

[aneftp]

Physician owned facilities are more efficient and profitable. But they are so because they skim the cream and cherry pick healthier patients and more profitable procedures, no emergency rooms, no sick as **** patients who require complex care.

So the alternative is to have hospitals own physician practice plus impose strict non competes radius to control salaries?

Hospitals aren’t exactly saving the public money. If hospital owns an office they can charge a facility fee. Worst that $50 ekg a small doc office charged now becomes a $200 ekg charge.

So more profits to hospitals. More cost to health system. Pay docs less.

 

[Lab Lover]

So the alternative is to have hospitals own physician practice plus impose strict non competes radius to control salaries?

Hospitals aren’t exactly saving the public money. If hospital owns an office they can charge a facility fee. Worst that $50 ekg a small doc office charged now becomes a $200 ekg charge.

So more profits to hospitals. More cost to health system. Pay docs less.

I am saying that I understand the arguments against physician owned facilities.

 

[aneftp]

I am saying that I understand the arguments against physician owned facilities.

What I don’t understand is the hospitals can merge and can have market share over the insurance companies and jack the rates on united healthcare and there is no ftc lawsuit.

Yet from when even private equity usap has market share in a region like Colorado. The ftc steps in to break them up because United healthcare is claiming usap is a monopoly that over charges them.

Why doesn’t the ftc step in once hospital system reach a 60% control over a region?

 

[Lab Lover]

Why doesn’t the ftc step in once hospital system reach a 60% control over a region?

Because they have better lobbyists. The AHA is very large and very effective.

 

[HemeOncHopeful19]

Nothing to see here. The ACA was the beginning towards universal HC and will be pegged to Medicare rates. All specialists including anesthesiologist will take a 50+% haircut. I wonder how the leftist docs on here will think when their salary drops by 50%.

Honestly they will just say “oh well we are supposed to be paid better but conservative politicians just won’t loosen the purse strings! They’re trying to starve the system but if everyone just voted harder left then we’d get good funding and be paid better!”

At least that seems to be the argument everytime someone points out <insert single payer system literally anywhere> pays their docs like crap

 

[HemeOncHopeful19]

What I don’t understand is the hospitals can merge and can have market share over the insurance companies and jack the rates on united healthcare and there is no ftc lawsuit.

Yet from when even private equity usap has market share in a region like Colorado. The ftc steps in to break them up because United healthcare is claiming usap is a monopoly that over charges them.

Why doesn’t the ftc step in once hospital system reach a 60% control over a region?

Once a hospital system reaches 60% control over a region they are generally the single largest employer spanning multiple congressional districts and nobody is going to risk threatening that machine.

This is one of the biggest reasons I don’t see an actual “solution” to healthcare in this century. Most of these bloated, inefficient systems have become literally too big to fail. You could get your chemo from my private office for 1/4 the healthcare spending of the non-profit mega system down the street but part of how we do that is by employing fewer constituents and being more efficient.

 

[rowsdower88]

Nothing to see here. The ACA was the beginning towards universal HC and will be pegged to Medicare rates. All specialists including anesthesiologist will take a 50+% haircut. I wonder how the leftist docs on here will think when their salary drops by 50%.

Arguing against all available evidence to the contrary...

Anesthesiologist salaries (can't speak for other specialities) have steadily risen since the ACA passed.

But any day now the sky will fall, we're on the precipice of universal healthcare and 50% pay cuts despite Republicans having total control of the federal government, lol.

Maybe the argument I'm missing is "well... maybe anesthesia salaries have risen steadily since the ACA was passed... but just think about how high they WOULD HAVE BEEN if it hadn't passed!? Everyone would be making aneftp level salaries even working part-time in SoHo!"

 

[dannyboy1]

Arguing against all available evidence to the contrary...

Anesthesiologist salaries (can't speak for other specialities) have steadily risen since the ACA passed.

But any day now the sky will fall, we're on the precipice of universal healthcare and 50% pay cuts despite Republicans having total control of the federal government, lol.

Maybe the argument I'm missing is "well... maybe anesthesia salaries have risen steadily since the ACA was passed... but just think about how high they WOULD HAVE BEEN if it hadn't passed!? Everyone would be making aneftp level salaries even working part-time in SoHo!"

Indeed. Anything that makes procedures profitable for hospitals is good for us. Anyone employed by hospitals could care less about CMS schedule cuts. I just want more demand for anesthesia services

 

[BobBarker]

Office ecg only pays $12. Insulting.

 

[emergentmd]

Anesthesiologist salaries (can't speak for other specialities) have steadily risen since the ACA passed.

But any day now the sky will fall, we're on the precipice of universal healthcare and 50% pay cuts despite Republicans having total control of the federal government, lol.

Not sure where I said specialists pay would go down with ACA. It will go down if Gov run Single payer starts. Just curious if the left on here would be OK with having their salaries cut in half. Because we all know what the gov will do with a Medicare for all system.

 

[emergentmd]

Indeed. Anything that makes procedures profitable for hospitals is good for us. Anyone employed by hospitals could care less about CMS schedule cuts. I just want more demand for anesthesia services

Economics 101 says everything is supply and demand. With a Medicare for all, the demand will go down as people will wait longer and denied elective procedures.

"Medicare" for all will not only drop RVU equivalents but will drop demand.

 

[rowsdower88]

Not sure where I said specialists pay would go down with ACA. It will go down if Gov run Single payer starts. Just curious if the left on here would be OK with having their salaries cut in half. Because we all know what the gov will do with a Medicare for all system.

You said "the ACA was the beginning towards universal healthcare".

So if you're using the ACA to predict what will happen to physician wages under a single payer system, it seems like the trend would be continued increasing wages for physicians.

Republicans control all levels of the Federal government and suspicions are high for a near-term recession, we are further from a single payer system today than at almost any point in time since Roosevelt.

If physician income plummets in the next decade, it is more likely due to other factors (trade war, actual war, weakening dollar...) as opposed to the onset of universal healthcare.

 

[TeslaCoil]

Except that sadly the ACA makes it illegal for physicians to own hospitals!

Smells like communism.

 

[kidthor]

Smells like communism.

Smells more like late stage capitalism, as it opened the doors wide open for private equity to steal everything.

 

[TeslaCoil]

Smells more like late stage capitalism, as it opened the doors wide open for private equity to steal everything.

in the end private equity wont be the problem. It will be the government stepping in. The government making it illegal for physicians to own hospitals is not a capitalistic principal at all. Its a socialist principal. But yea it basically had the unintended effect of private equity then taking over and stealing everything. Again, governments fault, and a great example of why socialism doesnt f'in work.

 

[emergentmd]

So if you're using the ACA to predict what will happen to physician wages under a single payer system, it seems like the trend would be continued increasing wages for physicians.

That is a huge leap but OK. The ACA increased insured people but insured through private insurance companies = more money. ACA converted to a Medicare for all system = decreased private insurance = Less money.

I didn't think I need to connect the dots but hope this helps.

 

[emergentmd]

Smells more like late stage capitalism, as it opened the doors wide open for private equity to steal everything.

I rather private equity run stuff than Gov.

 

[rowsdower88]

That is a huge leap but OK. The ACA increased insured people but insured through private insurance companies = more money. ACA converted to a Medicare for all system = decreased private insurance = Less money.

I didn't think I need to connect the dots but hope this helps.

Cool. So the ACA isn't really "the beginning towards universal healthcare" then or at least whatever connection you envisioned between the ACA, universal healthcare and physician wages is made up.

 

[emergentmd]

Huh? ACA increase cost for everyone. Eventually moves quicker towards bankrupting the system. Gov Take over.

 

[TeslaCoil]

Im going to plan an relatively quick endgame for myself in healthcare. 10 year time horizon. And im telling my kids to go into finance.

Huh? ACA increase cost for everyone. Eventually moves quicker towards bankrupting the system. Gov Take over.

exactly. The ACA will not last much longer I assume, and the the system will move toward more regulation and government control, unfortunately.

 

[rowsdower88]

Huh? ACA increase cost for everyone. Eventually moves quicker towards bankrupting the system. Gov Take over.

lol. This is the first time I've ever heard someone make the argument that the ACA is accelerationist.

I'll just say that this is a fringe viewpoint.

 

[rowsdower88]

Per AI:

While health care costs in the U.S. have continued to increase since the Affordable Care Act (ACA) was passed in 2010, they have done so at a slower rate than in the years prior to the law's enactment.

This slowdown in the rate of spending growth is attributed to a combination of factors, including the ACA's cost-containment provisions and broader macroeconomic conditions:

Slower Overall Spending Growth: Annual healthcare spending growth decreased from an average of 6.9% per year between 2000 and 2009 to 4.3% per year between 2010 and 2018.

Out-of-Pocket Expenses: A study published in JAMA found that the average annual increase in out-of-pocket healthcare expenses for individuals dropped from 3.4% (2000-2009) to 1.9% (2010-2018).

Macroeconomic Influences: Some of the slowdown in spending growth can be linked to general lower inflation rates in the period following the Great Recession (2010-2018) compared to the preceding decade.

ACA Provisions: The ACA included several provisions aimed at reducing cost growth, such as mandatory value-based payment initiatives through Medicare (e.g., penalties for hospital readmissions), the establishment of Accountable Care Organizations (ACOs), and the phasing out of the Medicare Part D "donut hole". Studies on these specific provisions have yielded mixed results, but some, like ACOs, have shown modest net savings for Medicare.

Increased Coverage: The primary goal of the ACA was to expand health insurance coverage, which brought millions of previously uninsured people into the system. While this increased overall health care utilization and spending as people gained access to care, it occurred amidst the general slowdown in the rate of cost growth.

In summary, while experts debate the precise extent to which the ACA itself caused the slowdown versus other economic factors, studies indicate that the rate of healthcare cost increases did decelerate after the ACA was implemented, and no studies have linked the ACA to an increased rate of spending growth.

 

[TeslaCoil]

lol. This is the first time I've ever heard someone make the argument that the ACA is accelerationist.

I'll just say that this is a fringe viewpoint.

What has happened to health insurance premiums since the ACA was enacted?

 

[TeslaCoil]

What has happened to health insurance premiums since the ACA was enacted?

AI Answer:

Overall Trends

• Gross premiums (the sticker price before subsidies) have generally increased over time, driven by factors affecting all health insurance, such as rising hospital costs, increased demand for medical services, and the rising popularity of expensive prescription drugs.
• In the initial years (2014-2018), the ACA individual market experienced volatility, with some sharp premium increases as insurers adjusted to new regulations, such as the requirement to cover pre-existing conditions and essential health benefits.
• By around 2019, the individual market began to stabilize, and premium growth became more similar to that of employer-sponsored plans.

Current Situation (as of late 2025)
Insurers have recently filed for significant gross premium increases for 2026 (an average of 26% nationally, or about 30% for states using Healthcare.gov).

• These increases are due to rising healthcare costs and the expected expiration of the enhanced premium tax credits at the end of 2025.
• If the enhanced subsidies expire, the average net premium payment for a currently subsidized enrollee is projected to more than double (a 114% increase) because they will lose most or all of their financial assistance and still face the higher sticker price. This could price many people out of the market.

 

[TeslaCoil]

Lets face the core of the problem. Americans are overworked, under-rested, overfed and under-exercised.

More from the AI:
Americans are not as healthy as people in other high-income countries, with lower life expectancy and higher rates of certain diseases, injuries, and preventable deaths. Despite spending significantly more on healthcare, the U.S. lags behind its peers in key health outcomes, such as infant mortality and life expectancy, though it performs better in areas like cancer mortality and stroke rates.

Key comparisons

• Life Expectancy: Americans live shorter lives on average than people in other high-income countries. The U.S. ranks 34th in life expectancy among high-income nations.
• Healthcare Spending vs. Outcomes: The U.S. spends more per capita on healthcare than any other country, but health outcomes are worse overall.
• Infant Mortality: The U.S. has the highest infant mortality rate among high-income countries.
• Disease and Injury Rates: Americans have higher rates of obesity, diabetes, drug-related deaths, and injuries and homicides compared to other high-income countries.
• Areas of Strength: Americans have lower death rates from cancer and stroke, and lower rates of smoking compared to many other high-income countries. Older Americans (age 75+) tend to have better survival rates than their counterparts in other developed countries.
• System Performance: A comprehensive report found that the U.S. healthcare system ranked last in overall performance compared to other wealthy nations.

Factors contributing to the disparities

• Health Disparities: There are significant health disparities within the U.S. based on race, ethnicity, income, and location.
• Social Determinants: Factors beyond healthcare, such as access to quality education, healthy food, and safe neighborhoods, contribute to poor health outcomes.
• Higher Costs: Higher healthcare spending has not translated to better health outcomes.

 

[rowsdower88]

AI Answer:

Overall Trends

• Gross premiums (the sticker price before subsidies) have generally increased over time, driven by factors affecting all health insurance, such as rising hospital costs, increased demand for medical services, and the rising popularity of expensive prescription drugs.
• In the initial years (2014-2018), the ACA individual market experienced volatility, with some sharp premium increases as insurers adjusted to new regulations, such as the requirement to cover pre-existing conditions and essential health benefits.
• By around 2019, the individual market began to stabilize, and premium growth became more similar to that of employer-sponsored plans.

Current Situation (as of late 2025)
Insurers have recently filed for significant gross premium increases for 2026 (an average of 26% nationally, or about 30% for states using Healthcare.gov).

• These increases are due to rising healthcare costs and the expected expiration of the enhanced premium tax credits at the end of 2025.
• If the enhanced subsidies expire, the average net premium payment for a currently subsidized enrollee is projected to more than double (a 114% increase) because they will lose most or all of their financial assistance and still face the higher sticker price. This could price many people out of the market.

You're saying the same thing as me.

Healthcare costs have risen, but at slower rates than the status quo prior to ACA.

So if anything, the ACA is slowing the arrival of our utopian single-payer system if the determining factor is outrage over Healthcare premiums.

 

[TeslaCoil]

You're saying the same thing as me.

Healthcare costs have risen, but at slower rates than the status quo prior to ACA.

So if anything, the ACA is slowing the arrival of our utopian single-payer system if the determining factor is outrage over Healthcare premiums.

no im not. Im saying that the ACA had direct consequences of causing insurance companies to raise premiums. then the fed provided unsustainable subsidies, and again, when those subsidies run out, because again, they are unsustainable, premiums will once again go up. What dont ya get?

 

[rowsdower88]

no im not. Im saying that the ACA had direct consequences of causing insurance companies to raise premiums. then the fed provided unsustainable subsidies, and again, when those subsidies run out, because again, they are unsustainable, premiums will once again go up. What dont ya get?

OK. That's all true (or at least I won't contest it now).

It's my understanding that the ACA has slowed the rate of increase in healthcare spending (2nd derivative). If you have evidence to the contrary that would be interesting.

So had the ACA NOT been passed, healthcare premiums would be higher today than they otherwise would be.

What you're talking about now (I'm not going to say it's a distraction, but it's close) are subsidies that were put in place during covid which additionally helped contain costs and are now the center of a legislative battle that is largely separate from whether or not the ACA slowed the rate of Healthcare premium increases.

 

[TeslaCoil]

OK. That's all true (or at least I won't contest it now).

It's my understanding that the ACA has slowed the rate of increase in healthcare spending (2nd derivative). If you have evidence to the contrary that would be interesting.

So had the ACA NOT been passed, healthcare premiums would be higher today than they otherwise would be.

What you're talking about now (I'm not going to say it's a distraction, but it's close) are subsidies that were put in place during covid which additionally helped contain costs and are now the center of a legislative battle that is largely separate from whether or not the ACA slowed the rate of Healthcare premium increases.

This is the most mentally challenged analysis I have ever heard.

Query: "Has the ACA lowered insurance premiums?"

AI Answer:
The Affordable Care Act (ACA) has had a complex impact on health insurance premiums: the unsubsidized "sticker price" for premiums generally increased, especially in the initial years, but the law's premium tax credits significantly reduced the actual amount most enrollees pay.

Unsubsidized Premiums
For those who do not qualify for subsidies (primarily higher-income individuals or those with access to employer coverage), the premium "sticker price" has generally risen. Analyses suggest that average individual market premiums more than doubled in the initial years after the ACA's main provisions took effect (from 2013 to around 2019), due to new requirements such as covering pre-existing conditions and essential health benefits.

Subsidized Premiums
For the majority of enrollees (over 90%) who receive federal premium tax credits, the ACA has made health insurance more affordable.

• Affordability with Subsidies: The actual monthly premiums paid by eligible enrollees are based on a sliding scale relative to their income, with tax credits covering a large portion of the cost.
• Impact of Enhanced Tax Credits: Temporary enhanced premium tax credits, expanded under the American Rescue Plan, have kept average out-of-pocket premium payments stable or even decreased them in recent years for eligible individuals. For example, the average monthly premium after tax credits for the lowest-cost plan on Healthcare.gov was projected to be $50 in 2026, which is lower than the average in 2020 before the enhancements.
• Potential for Price Spikes: The affordability for these enrollees is heavily dependent on the extension of these tax credits. If the enhanced subsidies expire (as they were projected to do at the end of 2025 in some analyses), the amount subsidized enrollees pay would more than double on average.

Summary
The ACA did not universally lower the base price of health insurance premiums; in fact, the unsubsidized rates increased for many people due to new market regulations. However, the law successfully lowered the cost to the consumer for millions of Americans through its system of premium tax credits and subsidies, making coverage more accessible, particularly for low- and middle-income individuals.


So basically if you are poor enough to qualify for a subsidized plan (44 million americans) then yea your costs went down. Duh. Everybody else's costs went up to pay for this disaster. I can tell you first hand my own premiums have skyrocketed. Even employer sponsored plans.

 

[rowsdower88]

This is the most mentally challenged analysis I have ever heard.

Query: "Has the ACA lowered insurance premiums?"

AI Answer:
The Affordable Care Act (ACA) has had a complex impact on health insurance premiums: the unsubsidized "sticker price" for premiums generally increased, especially in the initial years, but the law's premium tax credits significantly reduced the actual amount most enrollees pay.

Unsubsidized Premiums
For those who do not qualify for subsidies (primarily higher-income individuals or those with access to employer coverage), the premium "sticker price" has generally risen. Analyses suggest that average individual market premiums more than doubled in the initial years after the ACA's main provisions took effect (from 2013 to around 2019), due to new requirements such as covering pre-existing conditions and essential health benefits.

Subsidized Premiums
For the majority of enrollees (over 90%) who receive federal premium tax credits, the ACA has made health insurance more affordable.

• Affordability with Subsidies: The actual monthly premiums paid by eligible enrollees are based on a sliding scale relative to their income, with tax credits covering a large portion of the cost.
• Impact of Enhanced Tax Credits: Temporary enhanced premium tax credits, expanded under the American Rescue Plan, have kept average out-of-pocket premium payments stable or even decreased them in recent years for eligible individuals. For example, the average monthly premium after tax credits for the lowest-cost plan on Healthcare.gov was projected to be $50 in 2026, which is lower than the average in 2020 before the enhancements.
• Potential for Price Spikes: The affordability for these enrollees is heavily dependent on the extension of these tax credits. If the enhanced subsidies expire (as they were projected to do at the end of 2025 in some analyses), the amount subsidized enrollees pay would more than double on average.

Summary
The ACA did not universally lower the base price of health insurance premiums; in fact, the unsubsidized rates increased for many people due to new market regulations. However, the law successfully lowered the cost to the consumer for millions of Americans through its system of premium tax credits and subsidies, making coverage more accessible, particularly for low- and middle-income individuals.


So basically if you are poor enough to qualify for a subsidized plan (44 million americans) then yea your costs went down. Duh. Everybody else's costs went up to pay for this disaster.

You're AI prompt is missing my point entirely and illustrates our disconnect.

I've made the same point several times now.

But I'll reiterate it here simply:

- The ACA lowered the rate at which premiums rose.

- Premiums still rose under the ACA.

These aren't contradictory. Do you understand why?

I'll ask again, if we didn't have the ACA and if insurance premiums had maintained the same trend they were on prior to the ACA, would premiums be higher today or lower?

I think the answer is, based on the available evidence, higher.

 

[TeslaCoil]

You're AI prompt is missing my point entirely and illustrates our disconnect.

I've made the same point several times now.

But I'll reiterate it here simply:

- The ACA lowered the rate at which premiums rose.

- Premiums still rose under the ACA.

These aren't contradictory. Do you understand why?

I'll ask again, if we didn't have the ACA and if insurance premiums had maintained the same trend they were on prior to the ACA, would premiums be higher today or lower?

I think the answer is, based on the available evidence, higher.

You are a dodo.

Lets put it this way for you:

Query: "What effect did the ACA have on non-ACA plan premiums?"

AI answer:
The ACA caused a significant increase in premiums for non-ACA plans, especially the short-term market, because it shifted healthier individuals to ACA-compliant plans, leaving non-ACA plans with a sicker and costlier enrollee pool. Insurers in the non-ACA market had to raise premiums to cover the increased costs, as those with pre-existing conditions were now able to get coverage in the ACA-compliant market, and premiums in the individual market increased substantially after the ACA's full rollout.

How the ACA impacted premiums of non-ACA plans

• Adverse selection: The ACA made it illegal for insurers to deny coverage or charge higher premiums based on pre-existing conditions, which shifted the healthier population into ACA-compliant plans.
• Costlier enrollees: This shift left the non-ACA market with a disproportionately higher concentration of sicker, more costly enrollees.
• Increased premiums: To cover the higher medical costs of their remaining enrollees, insurers in the non-ACA market were forced to increase premiums.
• Market changes: This created a two-tiered system where non-ACA plans became a less viable option for many, particularly those who were healthy and could not qualify for subsidies.

The ACA's effect on premiums in the individual market

• Higher premiums: The ACA has led to significant premium increases in the individual market. From 2013 to 2017, premiums increased by an average of 105% in the individual market, and some states saw premiums triple after the ACA's full rollout.
• Subsidies and cost-sharing reductions: The ACA's subsidies and cost-sharing reductions were intended to make insurance affordable for low-income individuals, but they also contributed to premium increases.
• Unintended consequences: Some research suggests that the ACA's design may have created a market with higher premiums that many individuals can only afford through subsidies, even though the premiums themselves have risen.

 

[TeslaCoil]

To imply that the ACA has "curbed the rate of increase" in insurance premiums as a whole is m0r0nic.

 

[rowsdower88]

You are a dodo.

Lets put it this way for you:

Query: "What effect did the ACA have on non-ACA plan premiums?"

AI answer:
The ACA caused a significant increase in premiums for non-ACA plans, especially the short-term market, because it shifted healthier individuals to ACA-compliant plans, leaving non-ACA plans with a sicker and costlier enrollee pool. Insurers in the non-ACA market had to raise premiums to cover the increased costs, as those with pre-existing conditions were now able to get coverage in the ACA-compliant market, and premiums in the individual market increased substantially after the ACA's full rollout.

How the ACA impacted premiums of non-ACA plans

• Adverse selection: The ACA made it illegal for insurers to deny coverage or charge higher premiums based on pre-existing conditions, which shifted the healthier population into ACA-compliant plans.
• Costlier enrollees: This shift left the non-ACA market with a disproportionately higher concentration of sicker, more costly enrollees.
• Increased premiums: To cover the higher medical costs of their remaining enrollees, insurers in the non-ACA market were forced to increase premiums.
• Market changes: This created a two-tiered system where non-ACA plans became a less viable option for many, particularly those who were healthy and could not qualify for subsidies.

The ACA's effect on premiums in the individual market

• Higher premiums: The ACA has led to significant premium increases in the individual market. From 2013 to 2017, premiums increased by an average of 105% in the individual market, and some states saw premiums triple after the ACA's full rollout.
• Subsidies and cost-sharing reductions: The ACA's subsidies and cost-sharing reductions were intended to make insurance affordable for low-income individuals, but they also contributed to premium increases.
• Unintended consequences: Some research suggests that the ACA's design may have created a market with higher premiums that many individuals can only afford through subsidies, even though the premiums themselves have risen.

I still don't know if you understand my point because you won't engage with my questions.

Maybe reread the AI prompt I posed initially.

You're pointing to ways prices have increased since the ACA was implemented. I DON'T CONTEST THOSE.

The counterfactual I'm trying to get you to entertain is: what would have happened to insurance premiums if the ACA hadn't been implemented?

It seems like you believe premiums would be lower, so lets ask AI again.

AI prompt: "would insurance premiums be lower today if the aca wasn't implemented?"

Answer: No, insurance premiums would likely be higher today if the ACA wasn't implemented, especially for many individuals and families who are now subsidized. The ACA introduced subsidies that lower premiums for many, and without them, a significant number of people would face much higher costs. While some argue that removing regulations might have led to lower costs in certain areas, the current system's subsidies, which are a key feature of the ACA, prevent even greater premium increases for a large segment of the population.

 

[rowsdower88]

To imply that the ACA has "curbed the rate of increase" in insurance premiums as a whole is m0r0nic.

Lol. Why? The AI responses to the question (and reading I vaguely recall from years ago) suggest this to be the case.

@emergentmd argued the following:

ACA increase cost for everyone. Eventually moves quicker towards bankrupting the system. Gov Take over.

So my interpretation of this is that he believes that had the ACA never occurred people would have lower costs today and the system would be further from "bankruptcy".

I don't think this is the case for previously stated reasons.

 

[TeslaCoil]

Lol. Why? The AI responses to the question (and reading I vaguely recall from years ago) suggest this to be the case.

@emergentmd argued the following:



So my interpretation of this is that he believes that had the ACA never occurred people would have lower costs today and the system would be further from "bankruptcy".

I don't think this is the case for previously stated reasons.

And im arguing that you are wrong. and you are not asking the right questions. Insurance premiums for NON-ACA plans (aka the majority of Americans) would likely be lower. I dont care what anybody else says. The ACA immediately prompted a DOUBLING of insurance premiums. You cannot convince me non-ACA insurance plans would be higher today without the ACA than with. Its just ridiculous. Everything I sent you literally says that the ACA was the CAUSE of increased premiums. Where is your dysfunction?

 

[rowsdower88]

And im arguing that you are wrong. and you are not asking the right questions. Insurance premiums for NON-ACA plans (aka the majority of Americans) would likely be lower. I dont care what anybody else says. The ACA immediately prompted a DOUBLING of insurance premiums. You cannot convince me non-ACA insurance plans would be higher today without the ACA than with. Its just ridiculous. Everything I sent you literally says that the ACA was the CAUSE of increased premiums. Where is your dysfunction?

Let's try a better prompt for you:

Ai prompt: "did the aca slow the pace of insurance premium rise in the private market?"

Answer: "The Affordable Care Act (ACA) did not slow the pace of premium increases in the individual market immediately; in fact, premiums in that specific market initially increased sharply as the market adjusted to new regulations. However, the ACA has been associated with a slowdown in the growth of overall national healthcare spending, including premiums for employer-sponsored plans, which cover the majority of privately insured Americans.

Individual Market
Initial Increases: In the initial years after the ACA's implementation (around 2013-2018), individual market premiums saw significant spikes. This was due to factors like new mandates (e.g., coverage for pre-existing conditions), the end of temporary stabilization programs, and market uncertainty.
Recent Trends: In more recent years, particularly with the introduction and extension of enhanced premium tax credits, the net amount most enrollees actually pay has remained relatively stable because the subsidies offset the underlying cost. The "sticker price" premiums charged by insurers have continued to rise, driven by general healthcare cost pressures like hospital expenses and expensive prescription drugs.

Employer Market
The ACA's impact on the larger employer-sponsored insurance market has been different. The rate of growth in these premiums slowed after the ACA came into effect.
However, even in the employer market, premium costs are currently rising due to general inflationary pressures in the healthcare system.
In summary, the ACA's impact on premium growth varies significantly by market segment and the effect of subsidies. While the individual market saw sharp initial increases in gross premiums, the ACA has helped moderate the overall pace of national healthcare spending growth and, with the help of financial assistance, has made coverage more affordable for millions of people."

My summary:

So while there were initial price increases (especially in the individual market as you suggest) the overall impact on the majority of Americans has been a beneficial decrease in the rate of premium increases and "overall pace of national Healthcare spending".

 

[rowsdower88]

And im arguing that you are wrong. and you are not asking the right questions. Insurance premiums for NON-ACA plans (aka the majority of Americans) would likely be lower. I dont care what anybody else says. The ACA immediately prompted a DOUBLING of insurance premiums. You cannot convince me non-ACA insurance plans would be higher today without the ACA than with. Its just ridiculous. Everything I sent you literally says that the ACA was the CAUSE of increased premiums. Where is your dysfunction?

I think maybe the disconnect is on insurance premiums for specific populations? (Non-aca plans... but not employer provided plans?)

I'll concede that for the young, healthy, and wealthy insurance premiums would likely be lower today if the ACA had not passed.

But from what I'm seeing, the overall impact was modest cost control (relative to no-ACA) for the majority of Americans and especially for the sick and the poor.

 

[emergentmd]

You are a dodo.

You are arguing with a flat earther mentality. I try 2-3 posts and then just give up. The mental gymnastic is quite impressive. The government could make a law where car prices will go down 50% by subsidizing cars by 50%. If in 10 years, cars costing the same b/c of subsidies does not mean that car prices did not go up. It DID go UP, but now half is paid by uncle Sam.

ACA directly
1. Increased HDHP. In the long run, people paid more. Insurance is smart and they will be profitable. They just shifted costs to pts
2. Made owning a small medical practice almost impossible with all the dumb hurdles and regulations
3. Subsidies costs billions a year and has to be paid somehow. More taxes, more debt. Taxpayers are bearing this burden eventually.
4. Insurance carriers have increased profit to about 4x pre ACA

I can go on and on. I do remember the godfather of the ACA looking into the Camera and said that cost would not increase. Any increased coverage would be paid by the efficiencies baked in. Can someone tell me what these efficiencies are and how these saved money?

I am not even saying the ACA was a bad plan. Overall it may be good. But to argue that it did not raise over all costs is asinine. UHC of the world are printing money and the ACA was a big reason.

 

[aneftp]

Because they have better lobbyists. The AHA is very large and very effective.

Correct. It’s all a scam the healthcare system.
The goal these days is to make ur money and get out. Treat it like any job. Always do ur job to the best of ur ability. But don’t go over and above what is required.

This is the most mentally challenged analysis I have ever heard.

Query: "Has the ACA lowered insurance premiums?"

AI Answer:
The Affordable Care Act (ACA) has had a complex impact on health insurance premiums: the unsubsidized "sticker price" for premiums generally increased, especially in the initial years, but the law's premium tax credits significantly reduced the actual amount most enrollees pay.

Unsubsidized Premiums
For those who do not qualify for subsidies (primarily higher-income individuals or those with access to employer coverage), the premium "sticker price" has generally risen. Analyses suggest that average individual market premiums more than doubled in the initial years after the ACA's main provisions took effect (from 2013 to around 2019), due to new requirements such as covering pre-existing conditions and essential health benefits.

Subsidized Premiums
For the majority of enrollees (over 90%) who receive federal premium tax credits, the ACA has made health insurance more affordable.

• Affordability with Subsidies: The actual monthly premiums paid by eligible enrollees are based on a sliding scale relative to their income, with tax credits covering a large portion of the cost.
• Impact of Enhanced Tax Credits: Temporary enhanced premium tax credits, expanded under the American Rescue Plan, have kept average out-of-pocket premium payments stable or even decreased them in recent years for eligible individuals. For example, the average monthly premium after tax credits for the lowest-cost plan on Healthcare.gov was projected to be $50 in 2026, which is lower than the average in 2020 before the enhancements.
• Potential for Price Spikes: The affordability for these enrollees is heavily dependent on the extension of these tax credits. If the enhanced subsidies expire (as they were projected to do at the end of 2025 in some analyses), the amount subsidized enrollees pay would more than double on average.

Summary
The ACA did not universally lower the base price of health insurance premiums; in fact, the unsubsidized rates increased for many people due to new market regulations. However, the law successfully lowered the cost to the consumer for millions of Americans through its system of premium tax credits and subsidies, making coverage more accessible, particularly for low- and middle-income individuals.


So basically if you are poor enough to qualify for a subsidized plan (44 million americans) then yea your costs went down. Duh. Everybody else's costs went up to pay for this disaster. I can tell you first hand my own premiums have skyrocketed. Even employer sponsored plans.

correct. I’ve been telling people this.

Pre 2014. 100% of people paid individual healthcare without subsidies.

Now 90% of people depend on the subsides.

And everyone knows the only newly insured previously uninsured gains are really from Medicaid expansion. And and adding kids under 26 to plans That’s pretty it

Ask anyone u know who’s on the exchanges if they has healthcare previously. The answer is pretty obvious. They have. They aren’t newly insured. Yet thr govt keeps pumping up the numbers yeah we have 24 million on the exchanges and most have subsidies.

The liberals here are in such denial of these facts.

Wouldn’t it be better if those same people wouldn’t need subsidies? After all people didn’t need subsidies before.

 

[TeslaCoil]

You are arguing with a flat earther mentality. I try 2-3 posts and then just give up. The mental gymnastic is quite impressive. The government could make a law where car prices will go down 50% by subsidizing cars by 50%. If in 10 years, cars costing the same b/c of subsidies does not mean that car prices did not go up. It DID go UP, but now half is paid by uncle Sam.

ACA directly
1. Increased HDHP. In the long run, people paid more. Insurance is smart and they will be profitable. They just shifted costs to pts
2. Made owning a small medical practice almost impossible with all the dumb hurdles and regulations
3. Subsidies costs billions a year and has to be paid somehow. More taxes, more debt. Taxpayers are bearing this burden eventually.
4. Insurance carriers have increased profit to about 4x pre ACA

I can go on and on. I do remember the godfather of the ACA looking into the Camera and said that cost would not increase. Any increased coverage would be paid by the efficiencies baked in. Can someone tell me what these efficiencies are and how these saved money?

I am not even saying the ACA was a bad plan. Overall it may be good. But to argue that it did not raise over all costs is asinine. UHC of the world are printing money and the ACA was a big reason.

Precisely.

 

[rowsdower88]

You are arguing with a flat earther mentality. I try 2-3 posts and then just give up. The mental gymnastic is quite impressive. The government could make a law where car prices will go down 50% by subsidizing cars by 50%. If in 10 years, cars costing the same b/c of subsidies does not mean that car prices did not go up. It DID go UP, but now half is paid by uncle Sam.

ACA directly
1. Increased HDHP. In the long run, people paid more. Insurance is smart and they will be profitable. They just shifted costs to pts
2. Made owning a small medical practice almost impossible with all the dumb hurdles and regulations
3. Subsidies costs billions a year and has to be paid somehow. More taxes, more debt. Taxpayers are bearing this burden eventually.
4. Insurance carriers have increased profit to about 4x pre ACA

I can go on and on. I do remember the godfather of the ACA looking into the Camera and said that cost would not increase. Any increased coverage would be paid by the efficiencies baked in. Can someone tell me what these efficiencies are and how these saved money?

I am not even saying the ACA was a bad plan. Overall it may be good. But to argue that it did not raise over all costs is asinine. UHC of the world are printing money and the ACA was a big reason.

I guess he just gave up on AI explanations because they weren't going the way he wanted them to.

Specific populations aside, the general consensus is that the ACA (in conjunction with other macroeconomic factors) reduced the rate at which health care spending was rising. If emergent or tesla have sources that contradict this consensus, that would be interesting to see.

Fact Check: Have healthcare costs risen faster since the Affordable Care Act was passed? | Econofact

econofact.org

Name the much-criticized federal program that has saved the U.S. $2.3 trillion. Hint: it starts with Affordable

Despite constant criticism and occasional sabotage, the Affordable Care Act has successfully expanded health insurance coverage and helped control runaway health care costs.

www.statnews.com

How has U.S. spending on healthcare changed over time? - Peterson-KFF Health System Tracker

This chart collection explores National Health Expenditure (NHE) data from the Centers for Medicare and Medicaid Services (CMS).

www.healthsystemtracker.org

Edit: Maybe things have changed in the last couple years, would be sad if that was the case.

 

[aneftp]

I guess he just gave up on AI explanations because they weren't going the way he wanted them to.

Specific populations aside, the general consensus is that the ACA (in conjunction with other macroeconomic factors) reduced the rate at which health care spending was rising.

Fact Check: Have healthcare costs risen faster since the Affordable Care Act was passed? | Econofact

econofact.org

Name the much-criticized federal program that has saved the U.S. $2.3 trillion. Hint: it starts with Affordable

Despite constant criticism and occasional sabotage, the Affordable Care Act has successfully expanded health insurance coverage and helped control runaway health care costs.

www.statnews.com

How has U.S. spending on healthcare changed over time? - Peterson-KFF Health System Tracker

This chart collection explores National Health Expenditure (NHE) data from the Centers for Medicare and Medicaid Services (CMS).

www.healthsystemtracker.org

Edit: Maybe things have changed in the last couple years, would be sad if that was the case.

A self employed person with a family of 4 doesn’t care about any of this.

All he/she cares about is why in 2013 they were paying $700/month for healthcare WITHOUT subsidies with a $6000 high deductible and max 12k out of pocket expenses while making 100k a year without subsidies. (8.4% of their income going towards healthcare premiums)

Now in 2025. Even with inflation they make 150k a year but the healthcare premiums are now $2400/month (these are real numbers) with a $7000 deductible and max out of 13k (19.2% of their income)

And praying the Biden “enhanced” subsidies that expire in Dec 31 2025 because they make more than 400% of poverty for a family of 4. The law as originally written says no subsidies for them. Becuase they are over the 400% poverty line. Even though their healthcare premiums are more than 8.5%.

 

[rowsdower88]

A self employed person with a family of 4 doesn’t care about any of this.

All he/she cares about is why in 2013 they were paying $700/month for healthcare WITHOUT subsidies with a $6000 high deductible and max 12k out of pocket expenses while making 100k a year without subsidies. (8.4% of their income going towards healthcare premiums)

Now in 2025. Even with inflation they make 150k a year but the healthcare premiums are now $2400/month (these are real numbers) with a $7000 deductible and max out of 13k (19.2% of their income)

And praying the Biden “enhanced” subsidies that expire in Dec 31 2025 because they make more than 400% of poverty for a family of 4. The law as originally written says no subsidies for them. Becuase they are over the 400% poverty line. Even though their healthcare premiums are more than 8.5%.

Buddy. Chief. My guy.

If you or anyone else wants to make other claims about what is politically effective messaging or about what actual voters care about, that's fine. I'm not disputing that voters are upset with healthcare costs rising. They absolutely are rising.

I have a modest claim that seems to be acknowledged by multiple sources.

 

[pirate_doc]

It's really much simpler than a lot of the circle jerking going on in this thread.

Should health insurance companies be able to discriminate based on pre-existing conditions? If yes, continue pass go and develop your ideal capitalistic healthcare system.

If no, then you must develop single payer healthcare.

Not allowing insurance companies to risk stratify the people they insure (literally the foundational business model of any insurance company) ensures they provide little to no value but increase costs. You will have the worst of both systems. Which is what we have. Worse healthcare than most first world countries yet we pay twice as much per capita.

The majority of the voting public wants pre existing conditions covered. That's your answer.