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Obamacare and other similar efforts were never the solution needed to a broken healthcare system in the US, and acted with a mere band aid patching up effort not getting at the root causes for the breakdown in the healthcare system in the US. Pharmaceutical companies act with impunity in the US to price medicine in ways that are inimical to the lives of the people of the US. This is true also of other companies in the healthcare system in delivery of insurance plans and delivery of medical services.

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This Economist magazine editorial says the Republican plan for health care with its roll back of Medicaid expansion by limiting funding to states after 2020, and by scaling back subsidies especially for older Americans and not basing them on income levels, is likely to have its own problems just as the Affordable Care Act. One concern is that keeping healthy people in the market with a mandate that everyone have insurance is present but in a milder form with premiums going up by 30% in one year if they change their mind. There is concern that this may not work among insurers leading to an increase in premiums, pricing people out of the market in "a death spiral." This could lead to more people being priced out of the market as premiums rise. About 12 million people were added to Medicaid by increasing eligibility level to $16400, or 138% of poverty line- this reduced the uninsured from 16% in 2010 to 8.8% today. The Economist concludes that the Republican health care bill has its own problems, and that this bill does not clear up the problems in Obamacare by substituting Ryancare as the Republican bill is called. Peggy Noonan writing in the WSJ says this may have negative consequences for the new Republican base shift to populist support. Critics on the right like Rand Paul see even the reduced subsidies as an entitlement program, yet the Republicans can only change parts of the Affordable Care Act as they need 60 votes in the Senate where they only have a small majority.   ...

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Former Senator Jim DeMint lays out his reasoning for the Republican fight to defund ObamaCare, as the healthcare legislation is now called by Republicans. He points to problems with the legislation with issues about how much the added entitlements will cost in the future( more than the $250 billion by 2023 estimate of CBO insists DeMint based on the general lowballing of projections), and higher premiums for the young and elderly on exchanges. He says the 2012 elections were fought on economic issues not ObamaCare, and that the public he has met in visits to different states as president of the Heritage Foundation continues to be skeptical about ObamaCare. He sees the correct role of the Opposition party to point out the deficiencies in the law and call for corrections in the path for healthcare.

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.

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U.S. Senator Ben Sasse suggests an alternative approach of simply repealing the Affordable Care Act called Obamacare and replacing it at a later date. This is endorsed by president Trump. This is the new Republican strategy in July 2017. Forty nine senators voted in favor of this repeal in 2015, when president Obama vetoed this legislation. Two more senators are expected to support repeal according to Ben Sasse.

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The Affordable Care Act subsidies are basically a band aid approach to a fundamentally broken health care system in the US, says Washington Post Editorial Board on Nov. 1, 2025. The 22 million ACA subsidies will cost $350 billion over 10 years. Democrats have the government shutdown over this issue of extending Obama ACA subsidies where enrolment increased in the covid and Biden years with generous subsidies. The Washington Post looks at how we got here since 1945, decisions made about employer insurance plans that created a patchwork of plans from private sector and other plans outside it with perverse incentives and inefficient subsidies. It calls the system stupid, and politicians looking to the next 2 year midterm elections wary of addressing the whole problem in the proper way for a system that will benefit all the people of the US.

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Obama ACA subsidies to go directly to the people through Health Savings Accounts proposed by Republican Senators Graham, Scott and Cassidy in 2017, and again in 2025, and not to Insurance companies. In a post on his social media site DJT tells Congress that the ACA subsidies given directly to people rather than money sucking insurance companies would lead to a better result of people getting their own and better coverage for less money than under Obama type subsidies sent to insurance companies.  Much of Obamacare was done under a campaign from insurance companies and other health vested interests that undermined the original objectives so that however good the original objectives the watered down, disincentivising of reducing unproductive costs, led to a hotch potch band aid result. A common sense approach with the courage to get the right result that works for the people of the Nation to get good health care similar to Japan and other nations in Europe at reasonable cost is not a goal that an advanced nation like the US should see as unreachable or beyond our efforts, skills and wisdom. Obama and Bush failed, Bush in a major error to remove the negotiating power of government Medicare agency with pharmaceutical companies that Democrats failed to push back. ...

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The Affordable Care Act or Obamacare gave families of 4 with incomes of less than 125,000 or single income less than $60,000 a chance to buy insurance with federal subsidies. When these subsidies were increased under the IRA Act of president Biden the enrolment has doubled in the last 5 years to $24 million. These subsidies expire in 2025. Under the One Big Beautiful Act the policy of subsidies for ACA is not being renewed when it expires in 2025. This shows the band aid approach of Obama to healthcare and the lack of a comprehensive approach. The policy on migrants during the Obama and Biden administration also stretched public funding resources. Insurance companies now plant to make up for the los of subsidies from the government by raising prices for this subpopulation in a broken healthcare system in the US by 15-20%. This report in WSJ shows a young woman on ACA insurance in Illinois with a payment of $590 a month to Blue Cross of Illinois facing a new payment of $678, almost the size of a mortgage. ...

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Krauthammer cites Congressional Budget Office numbers that show the Obama U.S. health care law continues the spiralling costs of health care with new government mandates at a time of severe budget cuts in education and other areas- for 2013-2022 the costs come to $1.76 trillion. The initial Obama administration figures of 10 year costs of $938 billion announced in 2010 reflected the fact that the new U.S. health care law would take 4 years to fully go into effect. Costs after 2021 are shown to be $250 billion each year in the CBO figures. The law is now before the Supreme Court in 2012, which has to decide on the basis of the limits of the Commerce Clause.

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This NYT editorial on June 26, 2015, says the arguments of the plaintiffs before the U.S. Supreme Court for the Affordable Care Act were specious, based as they were on a reading of four words phrase in the Act leaving ambiguity about what exchanges were covered by health care subsidies. It says the plaintiffs with strong emotions on the subject decided to pull their argument out of thin air. That only one Justice acted as the swing vote, Justice Anthony Kennedy, shows the Supreme Court like the rest of the nation is not above emotion- Justice Scalia called the 6-4 decision based on "jiggery-pokery" and not "honest jurisprudence"- and needed Chief Justice Roberts to provide the larger view in 2015 as he did in 2012.

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NYT reports show the Republican health care bill AHCA 33 votes short of passing the House and likely to fail. Conservative Republicans were looking to whittle down the safety net in the Affordable Care Act, and moderate Republicans could not stomach the whittled down bill removing guarantees of essential benefits for instance. The basic problem- no real consensus among Americans about providing health care to all Americans, and no real solutions possible as long as there is acceptance of disproportionately high levels of medical care costs for treating each disease in the U.S. compared to Europe and other countries.

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John Cochrane, professor at the Booth School of Business, University of Chicago points to the simple truths about U.S. healthcare- out of control pricing because of the pathologies created by previous laws and regulations. He points out that costs are high in healthcare because regulations keep them high. Supply of new doctors is controlled because Congress and the AMA made it that way with a cap on residency programs and AMA opposing the expansion of medical schools. In a system of open competition new hospitals and health care businesses would challenge old ones which is not happening in a regulated market with regulations working to limit competition for the firms already in the business and with the influence to limit competition. Insurance costs for major expenses in an open and deregulated competitive market without the regulations would be so much lower than todays costs that its likely we would not even need a mandate such as the one the Obama healthcare law imposes.