OP here. This is Part 3 of my series on US Healthcare structural flaws.
The core argument is that the ACA’s 'Medical Loss Ratio' (which caps insurer profits at 15%) inadvertently created a 'Cost-Plus' incentive for inflation. Insurers bought Pharmacy Benefit Managers (PBMs) to 'launder' profits from the regulated insurance side to the unregulated PBM side via rebates.
I also dig into why the 'Association Health Plan' rule change in 2024 effectively locked small businesses out of the market.
GlibMonkeyDeath•Dec 1, 2025
I agree that the way the US pays for health care is completely broken, but your framing of the Association Health Plan rule change is strange to me.
Association Health Plans are a way to weaken the ACA, so Republicans can finally get back to the days of underwritten health insurance (i.e., de-facto denials for preexisting conditions via unaffordable insurance costs.) It has been in legal limbo for a while, and the Department of Labor finally (rightfully, in my opinion) seriously limited the scope of these plans.
AHP's are able to charge based on the "health" of the group, and aren't subject to covering the ACA essential items (like, say, emergency, maternal, or rehabilitation care.) This would encourage groups of "healthy" people to form low-cost plans that lacked basic coverage, and would leave "sick" people on ACA plans, which of course would go up in cost because of this.
We saw this in the bad old pre-ACA days. It's the classic death spiral that made most "high risk" pools basically non-functional before the ACA. The only option was to have a job through an employer with a large enough group plan that your rates wouldn't skyrocket. Otherwise, the option was usually bankruptcy.
Of course, literally every other modern democratic nation besides the US has figured out how to provide health insurance in one way or another without bankrupting their citizens. Maybe you could do another article showing how other countries systems avoid the US problems.
2 Comments
Association Health Plans are a way to weaken the ACA, so Republicans can finally get back to the days of underwritten health insurance (i.e., de-facto denials for preexisting conditions via unaffordable insurance costs.) It has been in legal limbo for a while, and the Department of Labor finally (rightfully, in my opinion) seriously limited the scope of these plans.
AHP's are able to charge based on the "health" of the group, and aren't subject to covering the ACA essential items (like, say, emergency, maternal, or rehabilitation care.) This would encourage groups of "healthy" people to form low-cost plans that lacked basic coverage, and would leave "sick" people on ACA plans, which of course would go up in cost because of this.
We saw this in the bad old pre-ACA days. It's the classic death spiral that made most "high risk" pools basically non-functional before the ACA. The only option was to have a job through an employer with a large enough group plan that your rates wouldn't skyrocket. Otherwise, the option was usually bankruptcy.
Of course, literally every other modern democratic nation besides the US has figured out how to provide health insurance in one way or another without bankrupting their citizens. Maybe you could do another article showing how other countries systems avoid the US problems.