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AUTHOR: R Quinn on 11/10/2025
I’m pretty sure we can agree when using the word “affordable” there are as many definitions as the number of people involved.
I observe the debate in Congress over the premium subsidies under the Affordable Care Act and wonder, what they are thinking.
Regardless of your views on that, we tend to forget we are all subsidized for our healthcare. It may be through the ACA, more often our employer, perhaps Medicaid and for many of us Medicare. Keep in mind the standard Medicare premium for Part B covers only 25% of the cost, the rest comes from general funds via taxpayers.
The problem with healthcare is that the reality is no amount being spent is affordable. You would be hard pressed to find someone who thinks their premiums and/or out of pocket costs are affordable no matter the source of insurance.
Sometimes trying to save money we trade lower premiums for potentially higher out of pocket costs which is fine until those costs are incurred. On the other hand, we may buy the best and most expensive coverage trying to protect ourselves, but that means we traded guaranteed monthly spending on higher premiums to avoid the potential out-of-pocket costs.
Sometimes our friends around the world may boast about their free healthcare and indeed when they receive care there may not be any out of pocket cost, but we all know it’s hardly “free.”
Under current law if the full premium for the benchmark Silver plan on a ACA exchange exceeds 8.5% of your income, you qualify for a subsidy to bring your net premium down to no more than 8.5% (or less, on a sliding scale for lower incomes). Who knows what may happen to that, but the question is, is 8.5% of income the affordable benchmark?
Since most employer plans are not income based, families often pay 10% or more of their pay in premiums with out-of-pocket costs adding even costs more, especially with high deductible plans.
The day before I retired our monthly premium for employer coverage, including Rx was $197, with a $1750 out of pocket limit per person. Today our total premiums are more than ten times that amount, but our out of pocket costs are limited to a deductible – $288 each (2026) except for prescriptions. The $197 was clearly affordable. We pay over $2,000 without financial stress, but it does not feel affordable. Ignore the IRMAA portion of premiums and I bet the basic premiums are not seen as affordable for many retirees, especially given they are not income based.
A friend told me he chose Medigap Plan L over Plan G because of lower premiums. Plan L has significantly higher out of pocket costs, but the premium is between $40 and $60 less than G with variations by location. Is that a good affordable deal? Maybe and maybe not. The 2025 out of pocket limit is $3660, (equivalent to $305 per month) but no coverage for excess charges by a physician. So, to save maybe $60 per month, the risk is incurring out of pocket costs equal to $305 per month, which over age 65 is, unfortunately, an easy cost to incur- trust me.
When it comes to healthcare what is affordable to most people is $0.
Hiding our out of pocket health care costs in a lifetime of taxes paid to achieve universal coverage and maybe “affordable” healthcare when we need to use it, doesn’t seem all that bad when you are faced with a large bill or very high premiums.
QUINNSCOMMENTARY 
“I’m pretty sure we can agree when using the word “affordable” there are as many definitions as the number of people involved.”
Unfortunately, the only definition that counts is the one Congressional Democrats imposed on the American households, but only some households. For single coverage, the “affordability percentage” is 9.96% of a household’s Modified Adjusted Gross Income, up from the 2025 plan-year level of 9.02%. So, if you earn the median wage in America, $62,712 (2nd Quarter 2025, BLS), your “affordable” contribution for individual coverage as a worker for an Applicable Large Employer is $6,246.11/year, or $520.50/month.
I observe the debate in Congress over the premium subsidies under the Affordable Care Act and wonder, what they are thinking.
There is no debate, just as there wasn’t any effective debate in 2009-2010. Republicans are thinking, they ignored everything I suggested, so, none of us voted for any of this, not in 2009-2010, and not in 2021, either. So, I thought this legislation was crap then, and I still do today – so, I’m not gonna change my vote now. Democrats are thinking that the 2009-2010 Democrate who went it alone and defined affordable all by themselves should have set it lower, in anticipation of continued health care inflation. Now they want a “do-over”.
Regardless of your views on that, we tend to forget we are all subsidized for our healthcare.
No, mine is not subsidized now, and it wasn’t at any other time. Any contribution my employers have made comes right out of my wages. Further, the amounts I caused to be contributed towards the cost of Medicare Part A far exceed the coverage I will receive. Similarly, the amounts I caused to be contributed to others Medicare Part B and Part D (general revenues) as well as the amounts I pay today, far exceed the cost of coverage. Finally, even if you say my employer-provided coverage is tax preferred, I am one of the Americans who paid income taxes, general revenues, that far exceeded any such tax preference for the past 55+ years.
The problem with healthcare is that the reality is no amount being spent is affordable. You would be hard pressed to find someone who thinks their premiums and/or out of pocket costs are affordable no matter the source of insurance.
Americans want the best health care coverage YOUR money will buy. It isn’t a function of “affordable”. PPACA was never focused on making health coverage affordable for anyone who doesn’t get a taxpayer subsidy. It was, is, and continues to be all about buying votes.
Since most employer plans are not income based, families often pay 10% or more of their pay in premiums with out-of-pocket costs adding even costs more, especially with high deductible plans.
Families? Yes? However, blame those who defined “affodable” in the 2009-2010 Health Reform law. No Republican voted for that. And, if you think that percentage is too high, ask yourself, who will be called upon to reduce the cost to the arbitrarily defined “affordable”.
No, Virginia, there is no Santa Claus.
If employers increase their contribution, it will directly or indirectly reduce workers wages. And, if employers shift spending from taxable wages to tax-free contributions towards the cost of health coverage, that will reduce revenues and increase the federal budget deficit, and ultimately, our national debt. Perhaps you forget, by raising taxable wages, and reducing tax free contributions, that was the Democratic plan to pay for much of Health Reform.
The day before I retired our monthly premium for employer coverage, including Rx was $197, with a $1750 out of pocket limit per person. Today our total premiums are more than ten times that amount, but our out of pocket costs are limited to a deductible – $288 each (2026) except for prescriptions. The $197 was clearly affordable. We pay over $2,000 without financial stress, but it does not feel affordable. Ignore the IRMAA portion of premiums and I bet the basic premiums are not seen as affordable for many retirees, especially given they are not income based.
The actual cost of your Medicare coverage, for a retiree and a spouse, could actually exceed $45,000. Assuming the most expensive Medicare Supplement “G” coverage, to keep the out of pocket to a minimum, the premium cost is estimated as:
Medicare A: $565/mo = $6,780 (typically paid via FICA-Med while working)
Medicare B: $202.9/mo (retiree paid) = $9,739 total
Medicare D (Standard) $38.99/mo (retiree paid) = $1,871.52
Medigap G (Ohio) $368/mo (retiree paid) = $4,416
Total cost: $22,806.72 PER PERSON
That would be $7,318 per person, per year in premiums – about one third of the cost to have 100% coverage and to be able to visit any physician who accepts Medicare.
“When it comes to healthcare what is affordable to most people is $0.”
Again, they want the best coverage YOUR money will buy.
“Hiding our out of pocket health care costs in a lifetime of taxes paid to achieve universal coverage and maybe “affordable” healthcare when we need to use it, doesn’t seem all that bad when you are faced with a large bill or very high premiums.”
Speak for yourself. I am already paying a lifetime of taxes and my coverage isn’t universal, nor “affordable” – at least, not by Democratic Congress standards. Spending more will only make it worse, make even more Americans dependent while increasing our already significant annual deficits and national debt – taxing those too young to vote and generations unborn.
If they continue to spend without taxing current Americans, why wouldn’t Americans believe that health care coverage can be had for “free”?
Stop, stop I say.
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