ACA health insurance will cost the average person 75% more next year
122 comments
·July 18, 2025brandonb
nothercastle
In this case they removed 2. Subsidies and mandates
tlogan
And they also added requirements what must be insured and maximum out of pocket.
So you cannot have a cheap insurance with 20k max out of pocket.
getnormality
My hope, perhaps naive, is that 95% of what happens in this Rube Goldberg machine basically amounts to the government paying private insurance companies to pay doctors, which is inefficient but ultimately straightforward.
potato3732842
>which is inefficient but ultimately straightforward.
That's an understatement on the order of saying WW2 was a rebalancing of geopolitical power.
Healthcare is what? 20% of GPD. Likely half of that is paper pushing compliance checking rubber stamping that likely ought not to exist.
getnormality
I was going to push back against this, but when I googled "what percent of American health care is administrative costs" I got back numbers ranging from 15-34%, which is pretty darn high. Much higher than the last number I heard, which was something like 8%. The factor of two variance is kind of disturbing in itself.
pjc50
Unfortunately there's a fraud problem, NOT by patients but by various entities claiming for unnecessary or never-performed procedures. https://pubmed.ncbi.nlm.nih.gov/25068880/
dgfitz
According to: https://fiscaldata.treasury.gov/americas-finance-guide/feder...
22 % Social Security
14 % Net Interest
14 % Medicare
13 % Health
13 % National Defense
10 % Income Security
5 % Veterans Benefits and Services
2 % Education, Training, Employment, and Social Services
2 % Transportation
1 % Natural Resources and Environment
3 % Other
mystraline
Yep, the ACA was originally RomneyCare.
Mitt Romney took the plan from the Heritage foundation (yes, the conservative neocon think tank). Hard low-controls capitalist plan.
Heritage foundation made this plan after Hillary Clinton pushed universal healthcare in 1994, as first lady. Howls of 'death panels' were heard all over republican talking points and radio shows.
(The 'death panels' aka rationing was seen as bad for government to do. However, we see a new type of rationing, based upon how much patients cost, and then denying care. That lead to the UHC execution, then approving more procedures, then getting sued by shareholders for that. Personally, government death panels are preferred to capitalist death panels.)
Put simply: Obama passed republican legislation put forth by a republican governor and a republican thinktank, and was deemed a socialist. And now, the program is basically destroyed.
toomuchtodo
Bipartisanship is dead. If you want to win, play to win.
brookst
Playing to win is dead. Current climate is play to kill yourself, so long as your opponent also does but suffers more.
bpt3
> However, we see a new type of rationing, based upon how much patients cost, and then denying care.
This is not at all new. It's how every other market operates.
For healthcare, which is not a normal market by any means, it might make sense to approach rationing differently because most people refuse to accept that rationing occurs at all, but cost will always be part of the picture.
mystraline
Its not JUST cost.
Insurance company covers person.
Person gets chronic ill, with covered disease.
Person is now 'less profit' or a cost.
Company, against contract, refuses to cover medication/procedures.
Company waits out patient to die.
The person is demonstrably wronged, but these companies can just wait sick people out. And that's precisely what happened with UHC. You know, Delay Deny Defend.
potato3732842
People need to take a step back and take the red/blue team fanboy emotion out of it.
It wasn't "destroyed" because it was "deemed socialist". It was destroyed because it used tricks of law to get something that didn't have broad enough support at the time done and those regulatory tricks were not durable. Same exact story as Roe v Wade but in a much more compressed timeline.
Unfortunately, the whole debacle has likely hardened the resolve of everyone who is against it even though a functional Romneycare system would likely be satisfactory to them (and needless to say an improvement over the status quo).
Turns out "the perfect is the enemy of the good, ship it" isn't how you run a society. This is a common theme. Stuff that's 50-50 either gets gutted or repealed with time. Something needs to be truly popular, like will lose you votes if you undo it, in order to stick around. For example no amount of pothead deadbeats or drunken wife beating is bringing weed or alcohol prohibition back at the state level.
We're 15yr on from the ACA and with very few exceptions things are worse. The nation likely would have been better served by letting the states that were inclined to run such systems continue doing so without federal meddling.
schmidtleonard
"The Democrats weren't able to stop Republicans from killing it, therefore it's the Democrats fault that Republicans killed it."
Instance #234535 of "the bar is never too high for Democrats and never too low for Republicans."
brookst
I don’t see how anyone can seriously suggest society must only use “perfect” policies. They don’t even exist. How does that help anyone?
ceejayoz
The regulatory tricks were upheld by SCOTUS.
Republicans just zeroed out the penalty in the individual mandate after that decision. They knew what that would do; that's why they did it.
Aunche
Romneycare wasn't really Republican , which was why it was it only passed in the overwhelmingly blue state of Massachusetts. Nixon signed OSHA, but nobody calls that Republican. The healthcare marketplace was proposed by the Heritage Foundation, but the state legislature added a lot of regulations and government assistance.
schmidtleonard
Yes, we know. It's not truly Republican unless it leaves the poor to die in a corner of bootstraps-itis. However, at the time the Heritage Foundation was still wearing the mask of caring because they hadn't pushed Single Payer out of the Overton window yet. It's bad optics to admit that you want the poor to die in a corner, so they had to pretend to have a solution and assistance was a cornerstone of the solution they pretended to have. The mask is off now, but history is history: it was part of their proposal.
ceejayoz
> Now that those subsidies are going away for next year, premiums are going to spike. For example, if someone paid $60 a month for their health insurance this year, they might be looking at $105 a month next year.
I was on the exchanges, unsubsidized, until this year. Last year's premium went from $3,000/month to $3,600/month. I had to buckle and get on a company plan with less coverage this year.
Meanwhile, every other piece of spare real estate in town is a new medical facility. Urgent cares, palatial orthopedic facilities… There's a crash coming.
hydrogen7800
>palatial orthopedic facilities
I'll see your anecdote with another anecdote. Around where I live, for the past few years there was a sudden massive ad campaign for a new orthopedist complete with billboards featuring the presumably founding doctor's smiling face, and various other print and sponsored ads. Their main building is a giant gaudy marble, glass and brass clad building, but there are others that have taken up more mundane buildings. I don't know how such a business launches so quickly with so much $$, but it must be PE. They've certainly got a lot of debts to pay off now, and I can imagine the assembly-line level of care with more focus on low-margin patient satisfaction, encouraging reviews about how nice and friendly everyone was, rather than actual effective care. This is of course my cynical uninformed take after seeing mucho $$ spent on advertising. Maybe they are actually great and effective doctors, for all I know.
BugsJustFindMe
> I was on the exchanges, unsubsidized, until this year. Last year's premium went from $3,000/month to $3,600/month.
I want to know details of your situation, because my exchange premiums are like $300/month.
ceejayoz
Platinum plan (which winds up most fiscally responsible for us - we max out the low out-of-pocket-max reliably), four people. Something like a bronze plan wouldn't save us any money; lower premiums trade for high deductibles and copays. Good if you're healthy.
null
bix6
Curious what the details of your situation are and how often you use healthcare?
bpt3
Either you have a high deductible, or you're just being subsidized by everyone else.
The unsubsidized cost of a standard PPO plan for a family can easily reach $3000 a month. This is situation normal, people just don't see it because their employer is responsible for the cost.
silisili
It's pretty sickening, to be honest.
For sobering data, check out the link below and look what happened in just 20 years. Unfortunately it stops at 2013, it's probably a solid orange blob today...
DennisP
We're likely to lose a lot of rural hospitals due to Medicaid cuts. We might need those new urban facilities, as those patients who do have insurance travel to the places still open.
analog31
What I read is that the big beautiful bill includes subsidies to keep those hospitals open, just not for them to treat patients.
BolexNOLA
> Meanwhile, every other piece of spare real estate in town is a new medical facility. Urgent cares, palatial orthopedic facilities… There's a crash coming.
Consolidation of hospitals/medical facilities/practices and the rapid spread of PE firms is absolutely destroying our already cracking healthcare industry. A crash is definitely coming. And just like with the financial crisis, we’re going to be the ones footing the bill and/or just dying on hospital steps.
Combined with so many doctors fleeing states with strict abortion/anti-LGBT laws, as well as the dismantling of programs encouraging doctors to work in under-served (often rural/low income/isolated) areas, it doesn’t take a genius to figure out who’s going to be hit the hardest.
jasonthorsness
Does “ACA health insurance” classification used here include everyone who buys insurance on their own who are not employed by a large-enough company or on Medicare/medicaid?
The job-based insurance system in USA is so bogus.
pitaj
Yep the biggest problem with the ACA was that it doubled down on health insurance as a benefit of employment, when it should have taken steps to transition everyone off of employer provided plans.
lalaland1125
It would be a political disaster to transition people off their employer plans.
The short term effect would be an increase in costs but no increase in pay for most people.
bryanlarsen
With a small tweak it would have the opposite effect. Just mandate that employers must add what they previously paid in health insurance to people's salary. So it would look like significant pay raises to a substantial portion of the populace. I bet that would be popular.
skybrian
No, not everyone. For example, you can buy health insurance from Kaiser either through the ACA marketplace or directly. But the ACA has tax credits that you wouldn’t get if buying directly.
crowbahr
It's kinda hard to tell in the article but it seems specifically to apply to subsidized ACA purchases. There are market rate purchases on the ACA site too - I don't expect those will go up. They're already ruinously expensive.
DennisP
Subsidies are going away but they're raising the unsubsidized rates because of that. This is the key paragraph:
> If healthy people opt out, the insurance pool is left with those who cost insurance companies more — people who can't go without health insurance because of chronic conditions or expensive medications. "That's why insurance companies are going ahead and charging a higher premium, with the expectation that the market is going to get sicker next year
lapcat
Every plan is market rate. There is no distinction between subsidized plans and market rate plans. The individual subsidies simply reduce the cost of the marketplace plan for those who financially qualify for subsidies.
Premiums for all plans have been going up basically every year, even for those who don't qualify for any subsidies.
jhfdbkofdchk
Only the plans you buy through the state marketplaces.
fkyoureadthedoc
I've never dealt with it before personally, are there other places you can buy plans as an individual? How do the prices compare?
ceejayoz
Prices are rough these days, because Republicans later removed the individual mandate. The system was never gonna survive that; it changes the economics entirely.
brandonb
Yep -- ACA health insurance refers to the individual market.
bix6
Man I thought we were getting raked with our 8% increase. 75% is unbelievable.
eddythompson80
> “Pretty much every insurance company is talking about the expiration of enhanced premium tax credits in the ACA markets“
If I understand this correctly, enhanced premium tax credits were extended to 400% federal income poverty level during COVID. (e.g: federal income poverty line for a household of 1 is 15k), right?
lenerdenator
As with all things that are inhumane that the government is doing, the behavior will continue until a negative stimulus is introduced.
KevinMS
> Now that those subsidies are going away for next year, premiums are going to spike. For example, if someone paid $60 a month for their health insurance this year, they might be looking at $105 a month next year.
If you payed $60 a month you were mega subsidized. I'm at about $500 a month (50s, single, bronze). There's no way I'm suddenly going to be around $900. This is either clickbait or a NPR scare tactic.
loeg
(It's the OBBBA and knock-on effects.) The bill's Medicaid cuts will also impact the ACA market and health infrastructure broadly in the medium term.
rsingel
In the renewal quote we just got, our small company premiums went up 12 percent while employee contributions went up 43 percent.
Don't know if that's just us or where the market is headed
daft_pink
I’m a little bit confused with how it will cost the average person 75% more?
Are the rates going up by the amount of the subsidy or are rates spiking significantly?
ThinkBeat
A bit of context from the article.
The Biden administration started to heavily subsidized some health care plans with Covid as the backdrop, and now those temporary measures are ending.
In so far as I have found and I might be wrong, congress never voted to fund and subsidize those medical plans indefinitely.
Now health insurance companies are raising their rates on those specific plans since the government is no longer partially funding it, or perhaps not funding them as much.
Then I am convinced the insurance companies raised their rates more then strictly required as they nearly always to to make even more money.
bilsbie
Does anyone know if the medi share plans are any good?
ceejayoz
https://www.propublica.org/article/liberty-healthshare-healt...
> For generations, members of the Beers family of Canton, Ohio, have used Christian faith to sell health coverage to more than a hundred thousand people like Martin. Instead they delivered pain, debt and financial ruin, according to an investigation by ProPublica based on leaked internal documents, land records, court files and interviews. They have done this not once but twice and have faced few consequences.
Even the legit ones don't have to cover stuff; they aren't health insurance. Even if they do, many facilities and docs won't take it, because they aren't required to cover things and they don't want the fight.
The ACA was originally designed as a "three-legged stool" of nondiscrimination (insurance companies can't charge higher rates to sick people), the individual mandate, and subsidies.
If you remove one of legs of the stool, the market becomes unstable and you see price spirals like this.
Jonathan Gruber (MIT econ professor, and one of the designers of the Affordable Care Act) gave a fairly detailed talk about how and why they designed the ACA the way they did, learning from a similar law in Massachusetts: https://youtu.be/2fTHqARiV_Q?si=SRC6Np-rjgUgAe4Z&t=679