While I am glad that 13 to 14 million uninsured people now have insurance (out of the 42 million in 2012), I have not been happy with what is out there now.
I work full time in EMS (Emergency Medical Service) for a mid-sized city, and part time in the Army Reserves.
My options for insurance have not gotten better since ACA, and most of the people I work with feel the same. Generally I'm not seeing ACA as a success, as much as just slightly better than what we had before, but not much.
Going to a Single Payor system would be better. But Obama and Congress don't seem to have any interest in that.
More after the squiggle for my ranting and personal views.
Mainly the reason my co-workers dislike how ACA is working is due to the view that it is unfair.
We work 12 hour shifts, three and four times a week. (they won't go to 24/72's because has a built in 8 hours of OT each week vs 8 hours every two weeks even though it means more coverage and faster response times)
We have a lot of contact with people for medical reasons and collect insurance information so the Metro Gov can bill them for the service the tax payer has already paid for. The big insurance we see the most of is called "Passport", a non-profit that pays its CEO about $1.2 million in total compensation according to Bloomberg. It is one of those Medicaid Plus things that manage Medicaid to save money by paying higher rates than regular Medicaid pays. (don't get it, how paying more means saving money)
What bothers most of my co-workers is that people with incomes under 138% of poverty level ($27,700 for a family of three) pay nothing, have no co-pay, no deductible. Yet the EMT making $11.37 an hour working 36 hour weeks and 48 hour weeks, (minimum number of hours a year - which NEVER happens due to mandatory OT and late runs) makes $26,100 but can't get medicaid because the employer offers ACA approved insurance.
Yes, the real reason will be that they made more than the 138% after OT and extra shifts. (70 to 90 hour weeks are not uncommon events in the world of EMS. Not every week, but often enough not to raise an eye to.)
So they see someone working part time at the head shop or tattoo shop on Passport at no expense to them, and they are paying between $280 to $670 a month for plans with $150 co-pays for ER visits, and $75 for walk in clinics, $50 doctor visits, and an 80/20 after a deductible in the $2,000 to $6,000 range. (max out of pocket cost $7,000 to $10,400)
This dose not make people happy. And it plays to the right wing's "the hard working person is getting screwed by the lazy poor" line.
So how does this get us to Single Payor?
Well, it won't happen all at once. We need to find ways to get the average person, the one currently getting pissed at the unfairness of Medicaid vs their plans, to support.
Use the military.
When I was on Active Duty, I had single payer health insurance. I had no out of pocket, no premiums, no worries about bills. I got sick, I went to the doctors. My spouse did the same. Oh, there were restrictions, we had to use the on post hospital/clinic, had no choice in who the doc was, and even then might not see "our" doc. If we were off post, the program (Tri-Care Prime) had some deductibles added over the years, and restrictions on who you could see.
Even better was if you did 20 years of Active Duty, you were promised this plan for the rest of your life and for a small fee your spouse would be covered after you died.
However, the GOP has been working to change this. (they hate single payor so much they are trying to kill it even though it is hurting the military) And I should point out that the Obama Administration has increased the effort to get rid of Tri-care for All Soldiers to save money by making them buy it in the market place. After all it would be cheeper for the Government if it did not provide insurance but had the Soldiers buy it out of their pay.
Instead of using the opportunity to expand the working popular Single Payer system, they are pushing the same things the GOP has: "why should a 38 year old be getting a pension from the military when they are working in the civilian world?" "why should the 38 year old be on Tri-care when their employer has a plan they could be on?"
What should be happening is demands that the post 20 year health insurance remain 100% free, and no costs. That it should be a selling point to hire retired vets that "they won't be using your insurance raising your costs as a business".
Then it should be expanded to include ALL military, Active, Reserve and Guard. Active military is about 1.3 million, with Reserve/Guard making up another 890,000. This would be 2.2 million people directly covered by Single Payer, and another 1.3 million dependents.
At this point it is hard to say "they don't deserve good insurance". They are the military, people who have chosen to serve the nation and have indicated they will be willing to die for it. Certainly that deserves some "perk". And you can't deny their families, that would be heartless.
Next you then expand the single payer plan to those who have been honorably discharged. They did their time, served well, and are entitled to the VA system anyways, why not reward all good service? This adds another 21.8 million. At this point you have close to 10% of the population under single payer.
Expanding Medicare downward, to 60 or 55, picks up another 20 million or so. The next step is to include the families of vets, another 13 million or so.
When you have 20 to 30% of the population under a very successful single payer system, it becomes very easy to "sell" the next step - everyone. You merge Medicaid into Medicare, expand the no-cost level to cover 300% of poverty (in steps while you expand the military program), and soon you only have a small segment of the very wealthy who tend not to serve in the military who are paying out of pocket or have employer plans.
It is not a great plan, but it sure is better than what we have now and harder for the right to attack.