[neltnerb]

Completely agree. The trick is making sure it's well-executed so that other states can use it as a template. Once one state proves that single-payer can be done well, I suspect it will cascade inevitably.

With 100% seriousness, if the ACA is repealed I will likely be choosing between Massachusetts (where Romneycare would hopefully take priority again) or another country. It's too risky to do otherwise.

My extended and immediate family members have too many horror stories about being denied coverage or it being prohibitively expensive. Like a cousin who had to choose working over being a stay-at-home mom to take care of her kids, since her husband's policy as an entrepreneur wouldn't cover her. She didn't even have any ongoing health problems, just a technical pre-existing condition.

I am unwilling to be stuck in a job or forced to accept unreasonable compensation or a nasty work environment because I have to have health coverage. Which is a decision too many in my family have been forced to make. Many family members (including myself) have far worse chronic illnesses, so it's utterly involuntary -- work or die. And thankfully I have a choice in where to live by virtue of my education and credentials.

I have been blessed so far to not have to deal with it because I've only lived in MA as an adult prior to Obamacare -- where Romneycare was in place by the time I finished undergrad. But I've heard enough first hand accounts and seen the suffering that kind of horrible choice creates. And the absolutely perverse incentives it puts onto the job market, and onto individuals. Health care is not a voluntary market, and treating it like one is bonkers.

Now I'm in California. I seriously doubt I will be able to stay without a guarantee that I can manage medical expenses, and I'm definitively privileged economically compared to the majority of the US population.

[zaroth]

California had guaranteed issue before the ACA. Any small business with at least 2 employees could get it. Premiums were reasonable as the "rating adjustment factor" was capped on these plans. A one time 6 month waiting period on pre-existing conditions is waived if you have prior credible coverage without more than a 62 day gap in coverage.

For example, a husband and wife working together in a sole proprietorship, would qualify.

I'm not sure the current state since ACA passed, but I depended on CA guaranteed issue myself for several years before ACA and it provided access to high quality expensive insurance (~$500 / person / month) with unlimited annual benefits, as well as somewhat cheaper HMO plans (~$350-400 / person / month).

Google 'AB 1672'.

[neltnerb]

Thanks, very helpful to know. Most of my family is in Ohio, and I'm a recent transplant to California.

This appears to be the updated version of AB 1672, which itself ended in 2013:

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?...

I'm not remotely capable of parsing all the stuff in there, but it does make me wonder what happens when a State passes a bill to bring itself into compliance with a Federal law and then the Federal law is repealed. I assume it's not automatic that the State bill ceases to function.

Is this even more of an uncertainty-laden mess than I thought? Will dozens of states find that changes to the ACA is interacting in crazy ways with state laws? Somehow I am guessing that we won't find out until it happens.

[andrei_says_]

> ... stuck in a job or forced to accept unreasonable compensation or a nasty work environment because I have to have health coverage.

Which is what makes this a huge political issue and an incredible leverage point.

I wish we could unite and end the use of healthcare coverage / availability to enslave workers ("enslave" being used loosely for the ones Who are as pedantic as I sometimes am).

[erichocean]

> It's too risky to do otherwise.

Uh, you could just buy insurance yourself. It's not like no-ones covered unless the State writes the check. smh