There are several other glaring flaws in ACA.
- extensive premium subsidies mean nothing when deductibles are 4-6k for low income people. Providers will not waive deductibles or send out bills to low income patients for elective procedures and visits; payment will be required in full at the time of service. So, in order to afford the treatment, low income/ high deductible patients will probably stop paying premiums to get some treatment. And qualifying for Medicaid would take some time to show that your annual income meets the requirement.
-the HHS wants to force providers to meet specific demands such as EMR and outcomes analyses. Apparently, this dictate would apply to commercial plans in 2015. This will force many small clinics and providers to fold because of compliance costs.
-lower Medicare reimbursement. This applies mostly to small clinics and providers. These independents will eventually go one of 3 ways: retire early, concierge/self pay, work at a large hospital group. In each case, productivity will be lower, and this will create a shortage of providers for the pool of insured patients.
A lot of people are going to pay out of pocket or else go to the ER; bankruptcy to follow.
"extensive premium subsidies mean nothing when deductibles are 4-6k for low income people"
For most people with a silver plan getting premium subsidies, "cost-sharing" subsidies are available to lower deductibles and copays.
"Medicaid would take some time to show that your annual income meets the requirement."
Expanded Medicaid enrollment in my state is effective immediately. Don't even have to wait for the 1st of the month. "Stated income" is used for the initial qualification but they do follow up with verification!