The Affordable Care Act is at best a byzantine zero-sum game with many winners and far more losers. Some gained coverage; others lost coverage (or crucial parts of their coverage). Some felt costs go down; others saw theirs go up. For some, care improved; for others, it deteriorated. The health care law likely means better health for some, worse health for others.
Those who gained coverage are easy to identify and assemble before television cameras; their potential coverage loss is simple to explain. In contrast, the law's casualties suffer in myriad ways that can be complex and often indirect. Archetypes may include:
- The guy who formerly had coverage but can't afford it now since the law pushed premiums through the roof.
- A woman who lost her top-of-the-line oncologist in the middle of chemotherapy because Affordable Care Act plans use skimpy provider networks to cut costs.
- A working-class family whose food, housing and education budgets are now badly squeezed by higher taxes and insurance premiums.
- The medical device inventor whose company can't survive the health care law's ruinous medical device tax, not to mention the patients whose suffering that device could ease.
- The fellow paying the individual mandate penalty/tax while receiving no benefits for it.
- The woman whose chronic care expenses used to be covered by insurance but whose $6,500 deductible today forces her to bear those expenses out of pocket.
- The couple who lost their jobs and benefits because the employer mandate forced their company to cut back on full-time employees.
- The woman who used to have high-quality insurance but now languishes in Medicaid waiting lines.
- The small-business owner who can't expand her company beyond 49 employees because of the health care law's employer mandate, along with the unemployed Americans she wished to hire.
- The man who refuses a job offer because he'll lose his Affordable Care Act subsidies if his income increases.
For actual Americans represented by these examples, the pain today is no less than the pain the health care law's repeal might – might – bring on others. But ironically, even that singular Affordable Care Act achievement, the coverage expansion, may well be partly ephemeral.
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