--- [ POLITICS ](https://mail.citywatchla.com/index.php?option=com_content&view=category&id=396) # Whether It’s Medicare, Medicaid, or the ACA, The Bill is Now Due Written by Ken Alpern. ![](https://mail.citywatchla.com/images/stories/Oct-2025/086n.jpg) October 27 2025 [](https://www.addtoany.com/share) [Comments](#disqus_thread) ALPERN AT LARGE - Whether it’s my work as a physician, or a neighborhood councilmember, or as a CityWatch writer, I try desperately to adhere to several principles—and they include being honest (tearing off that bandaid when it’s needed) and trying desperately to avoid hurting anyone’s feelings. Unfortunately, we live in an economic, political, and cultural climate where being honest will hurt feelings no matter what—even if it’s a warning with the best of intentions. And for anyone who’s worked with me, I very much DO have good intentions as a family man, a physician, and a civic activist. IN SHORT, EXPECT YOUR MONTHLY HEALTHCARE PREMIUMS IN 2026 TO GO UP, AND NOT JUST BY A LITTLE. I honestly don’t want this, and I honestly don’t want anyone reading this, or anyone you know, to go without health care…but health care is NEVER free because someone always pays for it, whether it’s YOU or SOMEONE ELSE. Much of why the government is in a shutdown mode, and the Senate is collectively freaking out on how to open up and restore a solid budget is because the bill is now due for the Affordable Care Act. Contrary to what many will think (considering I don’t hide my conservative leanings, either politically or economically) I AM NOT BLAMING ANYONE. We made a decision to tax ourselves, whether we realized it or not, with the Affordable Care Act (ACA), and whether it’s President Obama or former House Speaker Nancy Pelosi not really knowing the full implications of the ACA (I truly don’t know how many of us really knew)…we still taxed ourselves with the passage of the ACA. And the Supreme Court knew, because no matter how much the ACA was politically sold as something that was not a tax, Congress has the right to tax Americans. Yes, not a single vote in the GOP favored the ACA, but so be it. Elections have consequences, and even though [Texas Senator Ted Cruz ](https://www.yahoo.com/news/videos/flashback-cruz-forecasts-skyrocketing-healthcare-190640565.html)warned us that the bill for the ACA (let’s not call it Obamacare, okay…because health care is more than just political brinksmanship) would come due someday. And that day is now. NOW. The transition period of taxpayer subsidies is over, and so is the COVID pandemic. Taxpayer subsidies are at the heart of the Senate budgetary debate, because no one wants to tell seniors and other Americans (including those on Medicaid) that their health care premiums are going up. [As PBS explains](https://www.pbs.org/newshour/show/why-millions-of-americans-are-facing-a-spike-in-health-care-costs), health care premiums went up 6% in 2025, and will go up again, because the COVID relief packages and the Inflation Reduction Act had expiration dates for tax credits and other tax subsidies to absorb the pain of rising health care costs. We can blame President Obama and the Democratic Party, and we can blame President Trump and the Republican Party, and we can blame the health care industry, but we did as a nation choose in one way, shape, or form demand we all put more into the system to make sure health care was more accessible. And if we want to scream and decry the names “Affordable Care Act” and “Inflation Reduction Act” from the Democratic Party, I suppose that the “One Big Beautiful Bill” of the Republican Party is equally inappropriate and inaccurate. Politics is more often than not childish and insulting to one’s intelligence—hardly a new reality for any student of history or someone who follows politics. No blaming will prevent you, me, us, etc. from the MOST important thing of all—getting good health care in a timely and scientific and cost-effective manner. But costs are going UP, and I both dread and accept that reality, and so should you: If the [Kaiser Family Foundation (KFF) states](https://www.kff.org/affordable-care-act/aca-marketplace-premium-payments-would-more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/) that the ACA Marketplace Premium Payments for 2026 will [more than double](https://fiscaldata.treasury.gov/americas-finance-guide/national-deficit/#:~:text=In%20FY%202025%20total%20government,from%20the%20previous%20fiscal%20year) on average for many if current taxpayer subsidies and tax credits expire, then dread and acceptance are both warranted. But if in Fiscal Year 2025 government spending was $7.01 trillion and total revenue was $5.23 trillion, that means we had a $1.78 trillion deficit for this year (LINK: .) Are doctors and medical groups getting decreased reimbursement from the federal government from Medicare? Yes, and the medical community is screaming bloody murder. Are there lots of debates on whether those here illegally should access Medicare and/or Medicaid funds and services? Yes, there are, and the claims that “no, those here illegally don’t qualify for Medicare and Medicaid run afoul of local, state, and federal instances of those claims being proven untrue. Are employers under the gun during open enrollment for health care. Yes, they most certainly are. BUT THE BILL IS DUE, AND THAT’S TRUE WHETHER EACH OF US ARE READY FOR THAT REALITY OR NOT. So…what’s also true? Or at least my strong convictions based on over 35 years in the medical profession, and with the understanding that I’ve worked hard to reduce and or eliminate costs to my patients and medical group in order to achieve better access and health care? - If you’re working, and you’re not putting at least 10% of your gross, pre-tax salary into retirement, you’re screwing up bigtime and risk an old age of lousy, miserable poverty and subpar health care. In later years, that number should go up to 15-20% (but that’s not so necessary if you start in your 20’s). - If you can retire a few years later, or at least work part-time to keep saving and paying off debt before you physically cannot work, you should very, very strongly consider doing so. - The best type of health care a senior can have is (if you can afford it!) Medicare with a PPO supplement. - Medicare Advantage HMO plans can be excellent, but you’ve got to be locked into a health plan and a contracted medical group who will treat you like gold…and if you don’t know the difference between a health plan and a medical group, you better figure that out ASAP. - Whether you want to blame “mean” Republicans for demanding budgetary cutbacks, or “lying” Democrats for promising things that aren’t fiscally viable, that won’t save your physical health. THE BILL IS DUE. SAVE YOURSELF AND SAVE YOUR FAMILY. STOP LOOKING ABROAD TO ENGLAND, EUROPE, OR CANADA AS TO HOW THE GRASS IS GREENER FOR HEALTHCARE ON THE OTHER SIDE OF THE BORDER OR OCEAN. Budget better, soberly look at your finances and needs, and be realistic. And don’t skimp on your health care, in any way, shape, or form, to prove a point or to fight for a cause. Because in order to fight the good fight for your favorite cause or causes, you’ve got to be in excellent health in order to do that. *(Kenneth S. Alpern, M.D, is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud husband and father. He was active for 20 years on the Mar Vista Community Council (MVCC) as a Board Member focused on Planning and Transportation, and helped lead the grassroots efforts of the Expo Line as well as connecting LAX to MetroRail. His latest project is his fictional online book entitled The Unforgotten Tales of Middle-Earth, and can be reached at. The views expressed in this article are solely those of Dr. Alpern.)* [![](https://mail.citywatchla.com/images/ME%20DENTAL%20SPA/me%20dental%202026%20final.jpg)](http://medentalspa.com/) ![](https://mail.citywatchla.com/images/banners/signup-for-cw.png) ## Get The News In Your Email Inbox Mondays & Thursdays Website [ ![LA DWP #2 (Pay Your Bill Help)](https://mail.citywatchla.com/images/LADWP/dwp%20level%20pay%205-7-25.jpg) ](https://mail.citywatchla.com/component/banners/click/82 "LA DWP #2 (Pay Your Bill Help)") [ ![Home - HHR Rent is too High - SB-2](https://mail.citywatchla.com/images/HHR/AHF-rent-too-high.jpg) ](https://mail.citywatchla.com/component/banners/click/104 "Home - HHR Rent is too High - SB-2") --- ## Featured CityWatch Stories [ ![](https://mail.citywatchla.com/media/yootheme/cache/34/065h-34e1b43b.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33212:reminder-to-the-red-states-turnabout-is-fair-play&catid=395) ### [Reminder to the Red States, Turnabout is Fair Play](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33212:reminder-to-the-red-states-turnabout-is-fair-play&catid=395) GELFAND’S WORLD - Indiana has been pounded by rains that resulted in widespread flooding. While the rain was still comi… [ ![](https://mail.citywatchla.com/media/yootheme/cache/0f/061a-0f1ada2f.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33148:brace-yourself-for-a-worse-housing-crisis&catid=398) ### [Brace Yourself For A Worse Housing Crisis](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33148:brace-yourself-for-a-worse-housing-crisis&catid=398) PLANNING WATCH - The California State Legislature will soon vote on the following draft legislation. Please carefully… [ ![](https://mail.citywatchla.com/media/yootheme/cache/75/064a-75d5dbb3.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33199:your-boss-owns-your-workday-not-your-brain&catid=425) ### [Your Boss Owns Your Workday—Not Your Brain](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33199:your-boss-owns-your-workday-not-your-brain&catid=425) THE NEURAL WORKPLACE - California must protect workers before workplace surveillance crosses the final frontier: the hu… [ ![](https://mail.citywatchla.com/media/yootheme/cache/d0/065o-d02f23ac.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33213:californias-empty-classrooms-are-a-warning-sacramento-cant-ignore&catid=378) ### [California’s Empty Classrooms Are a Warning Sacramento Can’t Ignore](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33213:californias-empty-classrooms-are-a-warning-sacramento-cant-ignore&catid=378) A STUDENT'S VIEW - California is spending more on public education, yet classrooms are emptying, campuses are closing… [ ![](https://mail.citywatchla.com/media/yootheme/cache/fe/064i-febc3c1a.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33203:all-talk-no-action-nithya-ramans-reckoning&catid=401) ### [All Talk, No Action: Nithya Raman’s Reckoning](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33203:all-talk-no-action-nithya-ramans-reckoning&catid=401) THE BOTTOM LINE - Nithya Raman lost the homelessness gavel, and the most damaging verdict didn’t come from Republicans… --- ## [ POLITICS ](https://mail.citywatchla.com/index.php?option=com_content&view=category&id=396) [ ![](https://mail.citywatchla.com/images/stories/May-2026/038m.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=32722:californias-homeless-disaster-is-exploding-which-governor-candidate-has-the-courage-to-stop-it&catid=396)### [California’s Homeless Disaster Is Exploding Which Governor Candidate Has the Courage to Stop It?](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=32722:californias-homeless-disaster-is-exploding-which-governor-candidate-has-the-courage-to-stop-it&catid=396) [ ![](https://mail.citywatchla.com/images/stories/May-2026/041m.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=32762:tim-gaspars-political-problem-the-more-voters-learn-the-worse-it-gets&catid=396)### [Tim Gaspar’s Political Problem: The More Voters Learn, the Worse It Gets](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=32762:tim-gaspars-political-problem-the-more-voters-learn-the-worse-it-gets&catid=396) [ ![](https://mail.citywatchla.com/images/stories/July-2026/053a.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=32987:if-nithya-raman-cant-explain-socialism-why-is-she-asking-los-angeles-to-vote-for-it&catid=396)### [If Nithya Raman Can't Explain Socialism, Why Is She Asking Los Angeles to Vote for It?](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=32987:if-nithya-raman-cant-explain-socialism-why-is-she-asking-los-angeles-to-vote-for-it&catid=396) [ ![](https://mail.citywatchla.com/images/stories/July-2026/060a.png) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33130:an-interview-with-steve-hilton-candidate-for-governor-of-california&catid=396)### [An Interview With Steve Hilton – Candidate for Governor of California](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33130:an-interview-with-steve-hilton-candidate-for-governor-of-california&catid=396) [ ![](https://mail.citywatchla.com/images/stories/July-2026/059g.jpg) ](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33115:how-city-hall-contributed-to-the-decay-of-downtown-los-angeles&catid=396)### [How City Hall Contributed to the Decay of Downtown Los Angeles](https://mail.citywatchla.com/index.php?option=com_content&view=article&id=33115:how-city-hall-contributed-to-the-decay-of-downtown-los-angeles&catid=396)