Summary

ACA premiums, Obamacare subsidies, U.S. health insurance incentives, and healthcare cost inflation—WSJ economist Anthony LoSasso explains the real structural flaws.

Massive subsidy expansion, weak pricing discipline, and a structurally misaligned insurance market are driving rapid cost escalation across the Affordable Care Act marketplace. Wall Street Journal author and economist Dr. Anthony LoSasso breaks down why premiums are rising, why insurers face almost no pressure to compete on price, and how the ACA’s “defined benefit” subsidy structure created a distorted market.

In this episode of Analyzing Healthcare, host Roy Bejarano sits down with Dr. LoSasso to explore what the ACA got right, what it unintentionally broke, and how shifting to a “defined contribution” model could introduce real competition, lower premiums, and restore market discipline.

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What You’ll Learn

• ✅ Why ACA premiums continue rising despite stagnant utilization
• ✅ How the subsidy design shields consumers and removes insurer price pressure
• ✅ Why 98% of marketplace enrollees being subsidized distorts competition
• ✅ How defined-contribution subsidies could slow premium growth
• ✅ What policymakers misunderstood when designing the ACA
• ✅ Why ACA marketplaces became “happy times” for insurers

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Timestamps

• (00:00) Introduction to Dr. Anthony LoSasso & the WSJ article
• (02:20) The original ACA design and how incentives went wrong
• (05:00) Gross vs. net premiums: who actually feels the cost?
• (08:00) Why insurers face little pressure to keep premiums down
• (11:00) Defined benefit vs. defined contribution subsidies
• (14:00) Political narratives vs. economic realities
• (18:00) What the ACA solved — and what it unintentionally distorted
• (22:00) U.S. healthcare as multiple systems operating at once
• (27:00) Closing thoughts: creating a more competitive insurance marketplace

Key Takeaways

• 💎 The ACA’s subsidy structure unintentionally removed consumer price sensitivity
• 💎 Insurers face almost zero competitive pressure to lower premiums
• 💎 Defined-contribution subsidies could reintroduce market discipline
• 💎 Structural design—not utilization—is driving premium inflation
• 💎 The ACA succeeded in coverage expansion but failed on cost containment

Resource Links

Guest: Anthony LoSasso, PhD – https://www.anthonylosasso.com/

Host: Roy Bejarano – linkedin.com/in/roy-bejarano-a5669ba8

Organization: www.scale-community.com

Podcast Hub: Analyzing Healthcare by SCALE Community

Guest Bio

Dr. Anthony LoSasso is a nationally recognized health economist, former Professor at DePaul University, and incoming faculty member at the University of Wisconsin–Madison’s La Follette School of Public Affairs. He is the author of the Wall Street Journal analysis “The Real Fix for Obamacare,” and his research focuses on health insurance design, incentives, premium growth, and labor-market dynamics. His expertise spans ACA marketplace behavior, public-sector program design, and the interplay between health policy and economic outcomes.

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