Posted on Nov 2, 2025
Obamacare enrollee sees premium spike over 300% as sign-up period begins: 'This will devastate...
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We had a table talk with a friend whose mother gets $1362.00 per month and owns a modest 1200 sf. home. (no mortgage) She has 18 months to go before she is eligible for Medicare. A couple of years ago, she had to drop her ACA insurance because it became unaffordable due to her financial situation. His disappointment at her hardship centered on several issues, but one was that he believed the politicians had their own health plan that was a vast improvement over the public's plan imposed by Congress. Personally, I had no idea, so I decided to research the ACA plan for the general population and if it was the same for Congress. The result of my research follows:
Health Care for Members of Congress and Staff
1. The System They Use
• ACA Requirement: The Affordable Care Act (ACA) itself contains a provision that requires Members of Congress and designated congressional staff to purchase their insurance through an ACA-created exchange.
• Specific Exchange: They use the D.C. Health Link's Small Business Health Options Program (SHOP) exchange. While the plans are ACA-compliant, this is the small-business market, which typically offers different plans than the individual marketplace used by the general public.
• Plan Quality: They generally choose from Gold-level plans, which have a high "actuarial value" (meaning the plan covers about 80% of average medical costs, compared to the Silver plans on the public marketplace that cover about 70%).
2. The "Subsidy" They Receive
• Employer Contribution: Their financial assistance comes in the form of an Employer Contribution from the federal government, similar to what a large private employer would offer.
• How it's Calculated: The government contribution is based on the formula used for the Federal Employees Health Benefits (FEHB) program, which covers most other federal workers (like those at the FBI or NASA). The government typically pays about 72% of the average premium for the plan, with the member paying the remaining share.
• Key Difference from Public ACA Subsidies: This employer contribution is NOT income-based. It is a flat percentage of the premium, regardless of their income (which, as Members of Congress, is high).
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Health Care for the General Population (ACA Marketplace)
1. The System Used
• The general population uses the Individual Health Insurance Marketplace (e.g., HealthCare.gov or state-run exchanges).
2. The "Subsidy" Received
• Premium Tax Credits (Subsidies): The financial help they receive is called an Advance Premium Tax Credit (APTC).
• How it's Calculated: This assistance is strictly based on income and household size relative to the Federal Poverty Level (FPL).
o It is a sliding scale: the lower the income, the larger the subsidy, and the less a person has to pay for their premium.
o High-income earners (those above a certain FPL threshold, currently temporarily eliminated) do not qualify for these subsidies.
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Comparison: Is the Congressional Benefit "Larger"?
When you compare the two, the congressional benefit is often seen as being more generous than the standard ACA subsidy that a high-income family would receive, for two main reasons:
1. Income Test: The general public's subsidy (APTC) is income-tested and disappears for high earners. The congressional employer contribution is not income-tested and is paid regardless of their high salary.
2. Plan Quality: Congress members are encouraged to enroll in Gold-level plans with 80% coverage, while the ACA benchmark for subsidies is the Silver-level plan at 70% coverage.
In essence, while they are required to use an ACA-created exchange, their funding mechanism is a generous, large-employer benefit package (the FEHB formula) rather than the income-based, means-tested subsidy the general population relies on.
On a personal note, this program suggests the system is broken and not producing the healthcare benefits meant for the general population.
Health Care for Members of Congress and Staff
1. The System They Use
• ACA Requirement: The Affordable Care Act (ACA) itself contains a provision that requires Members of Congress and designated congressional staff to purchase their insurance through an ACA-created exchange.
• Specific Exchange: They use the D.C. Health Link's Small Business Health Options Program (SHOP) exchange. While the plans are ACA-compliant, this is the small-business market, which typically offers different plans than the individual marketplace used by the general public.
• Plan Quality: They generally choose from Gold-level plans, which have a high "actuarial value" (meaning the plan covers about 80% of average medical costs, compared to the Silver plans on the public marketplace that cover about 70%).
2. The "Subsidy" They Receive
• Employer Contribution: Their financial assistance comes in the form of an Employer Contribution from the federal government, similar to what a large private employer would offer.
• How it's Calculated: The government contribution is based on the formula used for the Federal Employees Health Benefits (FEHB) program, which covers most other federal workers (like those at the FBI or NASA). The government typically pays about 72% of the average premium for the plan, with the member paying the remaining share.
• Key Difference from Public ACA Subsidies: This employer contribution is NOT income-based. It is a flat percentage of the premium, regardless of their income (which, as Members of Congress, is high).
________________________________________
Health Care for the General Population (ACA Marketplace)
1. The System Used
• The general population uses the Individual Health Insurance Marketplace (e.g., HealthCare.gov or state-run exchanges).
2. The "Subsidy" Received
• Premium Tax Credits (Subsidies): The financial help they receive is called an Advance Premium Tax Credit (APTC).
• How it's Calculated: This assistance is strictly based on income and household size relative to the Federal Poverty Level (FPL).
o It is a sliding scale: the lower the income, the larger the subsidy, and the less a person has to pay for their premium.
o High-income earners (those above a certain FPL threshold, currently temporarily eliminated) do not qualify for these subsidies.
________________________________________
Comparison: Is the Congressional Benefit "Larger"?
When you compare the two, the congressional benefit is often seen as being more generous than the standard ACA subsidy that a high-income family would receive, for two main reasons:
1. Income Test: The general public's subsidy (APTC) is income-tested and disappears for high earners. The congressional employer contribution is not income-tested and is paid regardless of their high salary.
2. Plan Quality: Congress members are encouraged to enroll in Gold-level plans with 80% coverage, while the ACA benchmark for subsidies is the Silver-level plan at 70% coverage.
In essence, while they are required to use an ACA-created exchange, their funding mechanism is a generous, large-employer benefit package (the FEHB formula) rather than the income-based, means-tested subsidy the general population relies on.
On a personal note, this program suggests the system is broken and not producing the healthcare benefits meant for the general population.
Obamacare enrollee sees premium spike over 300% as sign-up period begins: 'This will devastate...
Posted from abcnews.go.com
Insurance
Finance
Edited 1 mo ago
Posted 1 mo ago
Responses: 4
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Just remember what the ACA was designed to do and is actually doing. It was to kill the health care system we had and create a single payer, ala the federal government. Obama care is doing just that.
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LTC Trent Klug
SGM Jeff Mccloud Name one area run by a government entity where costs were or are less expensive than the private sector. Even after investment timeframes.
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LTC Trent Klug
SGM Jeff Mccloud No, I didnt. The federal government has enumerated powers and healthcare/health insurance isnt one of them. Obamacare relied on the ability to mandate citizens into buying health insurance. This was found unconstitutional under the Commerce Clause. But the Roberts court found that it was Constitutional under the federal governments ability for the to levy taxes and fines. Which was not an argument either for or against the act in 2011.
The states have any power not enumerated by the Constitution, therefore Massachusetts could install Romneycare all it wanted. Just as Oregon did with the Oregon Health Plan. The federal government can't force a citizen to buy a product, but they did with Obamacare.
Was Romneycare designed to destroy healthcare in Massachusetts? It was a state policy and law with zero impact on federal policy or law.
I do know what Ocare did to medical practices, and to medical care costs in the United States. People who had insurance all of a sudden didnt because Ocare killed existing policies. "If you like your doctor, you can keep your doctor" became one of the greatest lies ever told to the American people and virtually ever lawmaker on the side of OCare wanted to go to single payer.
The states have any power not enumerated by the Constitution, therefore Massachusetts could install Romneycare all it wanted. Just as Oregon did with the Oregon Health Plan. The federal government can't force a citizen to buy a product, but they did with Obamacare.
Was Romneycare designed to destroy healthcare in Massachusetts? It was a state policy and law with zero impact on federal policy or law.
I do know what Ocare did to medical practices, and to medical care costs in the United States. People who had insurance all of a sudden didnt because Ocare killed existing policies. "If you like your doctor, you can keep your doctor" became one of the greatest lies ever told to the American people and virtually ever lawmaker on the side of OCare wanted to go to single payer.
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SGM Jeff Mccloud
LTC Trent Klug - Yeah, you're missing the point. You said the design was to burn it all down and force single payer. It was designed on Romneycare. Neither Romneycare nor ACA was designed to burn it all down. Pretty simple.
And yes, some people were not able to retain their existing coverage in 2010, if their original plan did not cover minimum standards, and it also did not legally prevent employers from dropping plans for any reason.
And yes, some people were not able to retain their existing coverage in 2010, if their original plan did not cover minimum standards, and it also did not legally prevent employers from dropping plans for any reason.
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LTC Trent Klug
SGM Jeff Mccloud Given that Romneycare was a failure and resulted in costs of $2 billion more than projected over 10 years and possibly more due to rising costs.
But, as Massachusetts has shown us, mandating insurance, restricting individual choice, expanding subsidies, and increasing government control isn’t going to solve those problems. A mandate imposes a substantial cost in terms of individual choice but is almost certainly unenforceable and will not achieve its goal of universal coverage. Subsidies may increase coverage, but will almost always cost more than projected and will impose substantial costs on taxpayers. Increased regulations will drive up costs and limit consumer choice.
"The answer to controlling health care costs and increasing access to care lies with giving consumers more control over their health care spending while increasing competition in the health care marketplace — not in mandates, subsidies, and regulation. That is the lesson we should be drawing from the failure of RomneyCare."
https://www.cato.org/policy-report/january/february-2008/lessons-fall-romneycare
But, as Massachusetts has shown us, mandating insurance, restricting individual choice, expanding subsidies, and increasing government control isn’t going to solve those problems. A mandate imposes a substantial cost in terms of individual choice but is almost certainly unenforceable and will not achieve its goal of universal coverage. Subsidies may increase coverage, but will almost always cost more than projected and will impose substantial costs on taxpayers. Increased regulations will drive up costs and limit consumer choice.
"The answer to controlling health care costs and increasing access to care lies with giving consumers more control over their health care spending while increasing competition in the health care marketplace — not in mandates, subsidies, and regulation. That is the lesson we should be drawing from the failure of RomneyCare."
https://www.cato.org/policy-report/january/february-2008/lessons-fall-romneycare
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MAJ Byron Oyler
I personally feel there is so much money in the insurance business that even the President of the United States (Obama) could not make it right. There were better options when Obama did this but he did not have the power. The profits are huge for these companies to the point they could pay to take people out who want to change their income channels. The cost I found when researching the site was $1700 a month for a family of four and the insurer could still decline coverage. It has become a beast that I worry is not fixable.
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LTC Matthew Schlosser
Alternatives include primary care memberships, cost-sharing programs, short-term health insurance, and discount cards.
The fundamental problem, even before Obamacare, was that health insurance wasn't insurance. Insurance spreads the cost of extremely unlikely catastrophic events, like your house burning down. Obviously, the risk of you going to the doctor an average of once a year is greater than 100%. That's not what insurance is for. Proper health insurance would cover things like cancer treatment and heart surgery, but not trips to the urgent care to get a prescription for a placebo like "prescription" mucinex. The fact that routine care is covered by insurance morphs insurance from the risk mitigation that it should be into a grotesque payment system that screws both patients and doctors while enriching middlemen.
The solution is to burn it all down and reinvent health insurance as something that only covers catastrophic events. Right now, you go get a strep test, you pay a $50 co-pay, the doctor charges the insurance company an additional $300, and the insurance company pays $20. And you're paying $1000 a month for that. Get rid of that nonsense and pay the doctor $70 instead of $50, and don't pay the insurance company $1000 a month! If health insurance only covered rarely needed expensive care, it would probably cost 1/10 of what people pay now.
The fundamental problem, even before Obamacare, was that health insurance wasn't insurance. Insurance spreads the cost of extremely unlikely catastrophic events, like your house burning down. Obviously, the risk of you going to the doctor an average of once a year is greater than 100%. That's not what insurance is for. Proper health insurance would cover things like cancer treatment and heart surgery, but not trips to the urgent care to get a prescription for a placebo like "prescription" mucinex. The fact that routine care is covered by insurance morphs insurance from the risk mitigation that it should be into a grotesque payment system that screws both patients and doctors while enriching middlemen.
The solution is to burn it all down and reinvent health insurance as something that only covers catastrophic events. Right now, you go get a strep test, you pay a $50 co-pay, the doctor charges the insurance company an additional $300, and the insurance company pays $20. And you're paying $1000 a month for that. Get rid of that nonsense and pay the doctor $70 instead of $50, and don't pay the insurance company $1000 a month! If health insurance only covered rarely needed expensive care, it would probably cost 1/10 of what people pay now.
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Obamacare was from the outset designed to destroy the health insurance market and leave no option but socialized medicine. When the ACA passed, the voters had no appetited for their doctor to be a government employee, but when their premiums are $5000 a month with a $100 co-pay for an urgent care visit, they'll rethink that. And that's PRECISELY what Obamacare is intended to engineer.
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