Three-Legged Stool

Note: I decided that while the original headline accurately reflected my feelings about this WSJ Op-Ed, it was a bit over the top, so I've changed it to something less crude.

For years, the Patient Protection & Affordable Care Act, generally shorthanded as the ACA or, more colloquially known as "Obamacare," was the top policy target of Republicans and other conservatives.

It seemed as though not a day went by without some right-wing opinion piece being published attacking the ACA for one thing or another. Once in awhile these attacks had some validity, but the vast majority were either completely baseless or grossly exaggerated.

And yet, after the dust settled on the infamous 2017 ACA "repeal/replace" debacle, it seemed as though the GOP had pretty much tired of their relentless assault on the healthcare law. They had failed to repeal it even with control of the White House, Senate, House of Representatives and Supreme Court, and ended up settling for zeroing out of the federal Individual Mandate Penalty as a consolation prize.

Last night I threw together my very first online ACA seminar for about 40 people (plus an unknown number of Facebook Live viewers, assuming I set that up correctly). It runs about two hours; the first half was pretty much an updated version of my normal "3-Legged Stool" explainer.

For the second half, however, I was joined by University of Michigan law professor & ACA expert Nicholas Bagley who helped explain the intricacies of the absurd CA v. TX lawsuit to strike down the entire Patient Protection & Affordable Care Act (aka "TX v. Azar", "Tx. v. U.S." or, as I prefer to call it, "Texas Fold'em".

If you have two hours to kill, you can watch the whole thing here! If you want to skip past the ACA 101 stuff and go straight to Bagley & I discussing the lawsuit ahead of this morning's Supreme Court oral arguments, that starts at around the 70 minute mark.

Yes, I'm still fiddling around with the 3-Legged Stool metaphor. I wasn't gonna mess with it any further, but gvien that Donald Trump has decided that making healthcare the biggest topic of the 2020 election cycle (again) is a brilliant strategy for the Republican Party, I figured it was time for an update.

The version below includes a bunch of changes; some are corrections; others are enhancements:

  • Moved "Maximum Out-of-Pocket Costs" to the Blue Leg, since that's really a carrier covrerage requirement.
  • Added "Stay on Parents Plan until Age 26" to the Blue Leg. I never had it listed before, not sure why.
  • Added "Health Insurance Exchanges" to the Green Leg. I never had them actually listed on the graphic, but they're an important Government Responsibility, after all.


It's time once again to talk about stools. Not step stools, but the Three-Legged Stool.

I posted this video explainer about the Affordable Care Act's "Three-Legged Stool" works last winter. The first 9 minutes or so covers why it exists, how it's supposed to work, how well it's actually working, the most obvious problems with it and the basics of how to fix them. The second half goes into the details of the half-dozen different awful repeal/replace bills that Congressional Republicans tried to push through throughout 2017.

Below is a condensed transcript version of the first half of the slideshow.

First of all, who is in the Individual Market? Well, what you're looking at right now is something a friend of mine dubbed The Psychedelic Donut. It's actually a depiction of the healthcare coverage, by type, of the entire U.S. Population...all 320 million or so of us.

UPDATE 5/4/18: On the one-year anniversary of the House Republicans passing their ACA repeal bill, I figured it'd be a good time to once again promote my 17-minute explainer video about why the ACA was necessary, how it's supposed to work, why some parts of it are very much in need of fixing/improvement and an overview of every one of the half-dozen different repeal bills that the GOP tried to push through last year.

Over 2,500 people have watched my 17-minute 3-Legged Stool explainer video to date, and many have given it high praise (especially considering the utter lack of production value). However, there've been a few complaints about a couple of patches which are a bit slow or where the slides accompanying the audio are a bit confusing, so I've added some additional slides and reworked a few others to make it more clear. I've also noted the most significant update: That in the end, yes, the GOP did indeed repeal the Individual Mandate.