Let's talk about...the impending collapse of the ACA and you

Whoa nelly. I went there.

If you haven’t been following, the ACA, the law that provides health care coverage and protections for millions of Americans, was invalidated by a judge in Texas late last year. But last week, the Justice Department said they now have the position that the entire law, not just the individual mandate, should be scrapped.

This is a big deal. This could affect, at a minimum, 21 million Americans.

This could mean the end of:

  • Provisions that eliminate denying coverage to people with pre-existing conditions
  • The federal subsidies that help cover the cost of insurance for those that can’t afford it but fall above the poverty line (“marketplace subsidies”)
  • Medicaid (low-income health care) expansion that covers 12 million Americans below 150% of the poverty line
  • Health care coverage for children whose families are above the federal poverty line but still cannot afford or find coverage through the Children’s Health Insurance Program
  • Access to opioid addiction treatment for low-income Americans
  • Ability to cover your adult child up til the age of 26 on your health insurance

From a NY times article on this situation

On average, the subsidies covered $525 of a $612 monthly premium for customers in the 39 states that use the federal marketplace, HealthCare.gov, according to a new report from the Department of Health and Human Services. If the marketplaces and subsidies go away, a comprehensive health plan would become unaffordable for most of those people and many of them would become uninsured.

Are you affected by this? I know I am. I get a $274/month subsidy for my health insurance which pays for my $3000/month drug and am personally uninsurable without the pre-existing conditions coverage.

How are you feeling? Hopeful still? Scared? Smug because you’re not an American?

Can the Americans just collectively cry over in a corner?


Hi. Yes.
I’m “safe” in the sense that I have coverage through my work and it’s reasonably priced, but Roommate buys her insurance through the ACA and it absolutely terrifies me, for her sake, in terms of the future.

1 Like

I was, for a while, planning on retiring early, recently shifting perspective that I will change careers.

The collapse of the ACA would mean that at minimum, myself or my partner would likely work for an employer enough for employer-provided health insurance, or work for ourselves successfully enough to pay for health insurance without subsidies, assuming that my pre-existing conditions of IBS and anxiety didn’t make companies refuse to insure me.

Being refused health insurance would also make it risky to do something like not work at all while training for a new career. Making it very likely that I’ll be attempting to work part time while doing career training while also raising kids.

It flat-out sucks. Neither my partner or I want to be tied down to an employer besides ourselves forever. And we are merely inconvenienced in terms of our future hopes. We’re not the ones totally fucked over in our present by this.


Yea, this is the thing that scares me the most. Quite simply, my experience before the ACA was that no amount of money could buy me anything other than crappy catastrophic coverage that wouldn’t cover anything other than a massive wreck. There just weren’t available options to buy as a self-employed person or employee without coverage.

The subsidies are important, but access to the marketplace and the ACA limits to out-of-pocket-maximums, lifetime limits, coverage for pre-existing conditions and the guarantees of coverage of preventative care… all to these things, so important.

My state is very liberal and will want to try to keep the marketplace going, but we also are broke and there’s no way we can afford the subsidies or medicaid coverage.

I would enjoy crying over in the corner with you. I mean, not enjoy. But.

I was on the ACA for several years when I was a contractor. I certainly couldn’t have afforded it without subsidy. Now, the constant threat of losing the ACA means that I have steadfastly never jumped to doing freelance work, even though I’ve been tempted many times over the years.

One of my closest friends lives in Germany and is planning to stay there forever because she has a whole host of expensive conditions, some degenerative, and she’s so worried about the loss of the ACA that she will never come back. (She, by the way, is a highly educated, high paid worker of the type that most countries really don’t want to lose.)

1 Like

Yeah. Some states, if it really does go to hell, will be ~okay. Minnesota is one, I think.
I have little faith. Shit has gone wrong here for too long. :confused:

All the fiscal estimates I’ve seen have said the only state that could afford to keep up Medicaid expansion and the subsidies for marketplace coverage is California (which has the 5th largest economy in the world if it was its own country). Every other state couldn’t afford it.

Well balls.

Come live with me. Except our rent here is so $$$$ you may not actually save money.

Does California have any middle-of-nowhere places that aren’t bonkers expensive?

I don’t need to live near people. Though I do need to live near internet.

1 Like

Yea lord almighty I don’t think I could ever live in California. Love to visit, always want to go home. The taxes from every angle kill me.

Maybe LA if my youtube career ever takes off from my current 203 subscribers :wink: I’d just have to live in a bikeable area and never go anywhere else in LA.


I’m not personally going to be affected because, honestly I didn’t think the ACA would last/be that workable so I never relied on it and never had to, and with all my pre-existing stuff buying insurance outright is a minimum of like $1200 a month anyway. Before the ACA I was in the pre-existing conditions denial group (still am) and did have to pay out of pocket bc I didn’t get coverage through work. I had to get family help for that or I would have been totally fucked.

The only reason things are fine for me now is because I’m married to a guy with a well paying job and great health insurance. Husband will probably not retire early no matter how much wealth we accrue, just for the health insurance alone…unless we move to another country, which is something we talk about occasionally.

This will destroy a lot of people, though. Basically everyone who isn’t rich like I am, or who doesn’t have affordable health insurance through work, is fucked. I don’t get it because even if you don’t give a shit about human beings, do you REALLY want there to be a massive financial crisis? Medical costs are the #1 cause of homelessness. It’s ridiculous. If for no other reason, keep it for economic stability!

1 Like

I honestly predict a slew of marriages. I won’t lie and say it’s not something I’ve considered, either. I highly doubt Roommate would go for it, bc she’s of the rebellious and principled variety, but still.


If you want to talk about it, I’m really curious about this, because it wasn’t clear to me there was anyone still in this group. I’d love to know more about it.

I’m definitely fucked for the rest of my life at this point due to my reliance on a biological being on my medical record. I was in a messy situation before the ACA, with no health care coverage and rapidly degrading joints, and the only thing constant about my health care situation now is a low-level panic that it could be taken away at any point.

1 Like

I’ve personally been witness to at least 3 different health insurance marriages, 2 immigration marriages, and 2 financial aid marriages (if you’re under 24 in the US you need your parents’ information for financial aid, unless you’re married or military or have kids. If you’re no-contact with them, getting married can mean you can expedite the process).

1 Like

Oh, that was unclear-sorry! I meant if the ACA all goes away I will be back in that group again bc I have a degenerative disability, not a short term/temporary thing. I have no advice for your situation unfortunately, I’d be sunk if I were on my own (in a lot of ways) <3

Oh thanks! I was worried there was something that I didn’t know about that and it seems like something I should talk about on the show!

For myself: I might just to get a corporate job (never had one, what are those like lool) or have to get married which not a thing I’m generally jazzed about (and then SSO would have to keep the fancy-pants job.) Germany and Ireland would take me as far as I can tell, the UK and Canada would not.

1 Like

Hm, maybe we should start a “where to be a healthcare-related expat” thread? Oh, or ARTICLE?

If I’m not careful I’m going to end up just with a pile of article ideas on my computer.


Before I was married I did corporate jobs and worked at a college for a few years (doing software things), and both of those did have good coverage plus other benefits, but I was able to do full time hours at that point, so yeah.

1 Like

Yea, I’m extremely lucky that for the moment, as long as I keep having access to Miracle Drug :tm: then I will be able to do full-time hours. I’m just not super employable in large corporations due to my extremely non-profit-y and small business skillsets. Also, I umm, like my current situation, except for scary scary health insurance situation.

Do it! (Seriously OMD will pay for this article).

1 Like