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[Ms. Toad]

148. Well - you probably put me in the ACA gang

since I pushed hard for it over the only other realistic option - which was no change at all.

Part of the reason that something had to change - even if it was not the change I would have preferred - is that there were not places, things, or services for way too many people. Everyone I know who supported passing the ACA did so not because it was a wonderful plan, but because there were millions who had no access to health care under the existing system. It was a choice between doing nothing as a protest against legislation which could be passed but was far from ideal - and pushing for some change that would create more access for more people.

The removal of mandatory participation in the Medicaid expansion program by the Supreme Court is being used as a spiteful tool by people who believe everyone should just pull themselves up by the bootstraps. I don't know how to fix that (and I am not suggesting it is the only problem - but it is the most egregious one). That change means now that two groups which cannot afford it will be particularly hard hit - those with little to no income in a state which refuses to expand Medicaid, and those folks near or just above the subsidy cutoff who can barely make ends meet. And - within those groups those with chronic illnesses will be hardest hit. That includes my own family once my daughter hits 26. She will be paying not only premiums every single year, but also the maximum out of pocket every year - unlike relatively healthy people her age. That means her health care costs will be at least double the cost of her similarly situated healthy peers.

But - it is still better than the current system, given that she is almost certainly heading for at least one transplant.