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reliabilityguy 4 hours ago

> ACA?

How’s ACA hard-hitting on corporations?

The 15/20 rules is what resulted in recorder profits in health insurance business, how’s this anti-corporate?

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ajross 3 hours ago | parent | next [-]

> How’s ACA hard-hitting on corporations?

"You must sell insurance to sick people!", "I don't wanna!", "I don't care, the law now says you must."

I mean, the whole insurance industry had spent the better part of a century (basically its whole existence) denying coverage to people with pre-existing conditions, and the ACA fixed it via fiat.

Not only is it clearly "hard-hitting", I'd argue it's probably the single most "hard-hitting" invasive change to corporate regulation of the post-war era. Certainly it is in terms of the amount of money involved in the affected market.

> how’s this anti-corporate?

And this is where the rub is. You're not saying that your desired regulatory structure is something different than existing proposals, you're demanding that your government engage in behavior that is expressly "anti" whatever you perceive "corporate" interests to be.

That's not democracy, that's just warfare. You have enemies and you want to win. And the problem there is that the structure of our government requires compromise.

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travoc 3 hours ago | parent [-]

ACA literally forced every person in the US to become a customer of health insurance companies.

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3 hours ago | parent | next [-]

[deleted]

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ajross 3 hours ago | parent | prev | next [-]

It "literally" did not. What enforcement exists is financial (a tax penalty) and not compulsory. And obviously most people are covered via employer plans or Medicare, as has always been the case. A quick Google says that 19.2M Americans are enrolled in ACA plans. I don't have statistics, but I'd bet that the overwhelming majority of those are willing purchasers. Most people view health care as desirable.

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lotsofpulp 3 hours ago | parent | prev | next [-]

No, it didn't. If you didn't want to buy health insurance, you just had to pay a couple extra thousand in federal income tax:

https://landline.media/affordable-care-act-tax-penalties-end...

>The penalty for not having an ACA-compliant plan or forgoing coverage in 2018 is the greater of $695 per adult and $347.50 per child for a maximum of $2,085 or 2.5 percent of adjusted household income. The percentage penalty is capped at an amount equal to the national average premium for a bronze plan, the minimum coverage available by law

	▲	scottyah 3 hours ago \| parent [-]
		Ah yes, the very hard hitting anti-business rule that says if you don't become a customer of my friend's company, you must give me money. I'm sure the businesses were quivering in their boots when every citizen either became a customer, paid a fine, or became a felon.

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ptaffs 3 hours ago | parent | prev [-]

The "everyone has access to the ER" has to be paid somehow, which is through tax dollars. The USA has a for-profit health system but typical neo-liberalism has a safety net where corporates get to dip into a different bottom-less pot. So it makes sense that we make this visible by taxing everybody who isn't paying their own insurance, since they still expect access to ER.

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lotsofpulp 4 hours ago | parent | prev [-]

Then why do the 7 publicly listed health insurers have shitty shareholder returns?

If their profits are so good, their shares would be worth owning.

Could it be because their profit margins are actually terrible (3% if lucky), and they have to get the price of their product approved by 50 different state government employees, and the federal government constantly changes their customer’s subsidies making revenue and expenses extremely volatile and difficult to forecast?

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eli 3 hours ago | parent | next [-]

If you bought shares of those 7 companies in 2010 when the ACA passed, how much would you have today? More or less than if you bought the S&P 500?

If you're looking for policies to blame for insurance companies having a rough 2025-2026, look to the Republican-led efforts cap Medicare fees and alter eligibility requirements.

	▲	lotsofpulp 3 hours ago \| parent \| next [-]
		You would have about the same or less. Maybe UNH gets you a couple extra percentage points per year, but that's because they have an enormous healthcare provider business instead of just being an insurer. But it's still nowhere near a positive risk adjusted return when comparing to a relatively risk-less investment in SP500. https://dqydj.com/sp-500-return-calculator/ https://dqydj.com/stock-return-calculator/ Since Jan 1, 2010, 18% for UNH, 15% for MOH/CNC, 14% for CI/ELV/HUM/SP500, 8.5% for CVS. Also, these businesses are competing to sell a completely fungible commodity good with tons of non profits like Kaiser Permanente, HCSC, Cambia, Independence Blue Cross, and many others. It makes no sense to expect those businesses to be able to earn any decent profit margin when their competition only needs 0%.
	▲	jpadkins 3 hours ago \| parent \| prev [-]
		[dead]

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Gareth321 3 hours ago | parent | prev [-]

> Then why do the 7 publicly listed health insurers have shitty shareholder returns?

CNC is up 90% YoY. That's far more than any of the largest tech companies. Alphabet is the highest of the tech stocks, and it's up 38% in the same period. When we look at the performance of the seven large U.S. publicly traded health insurers, their returns were extraordinary in the decade following the ACA.