to a significant consolidation of the provider industry. The increased market share gave them more leverage with insurers and reduced patient care options. Repeal The House, led by Republicans, repeatedly voted to repeal PPACA, but Senators did not follow suit. Economic consequences CBO estimated in June 2015 that repealing PPACA would: Decrease GDP in the short-term, as government spending (on subsidies) was only partially replaced by spending by recipients. Increase the supply of labor and aggregate compensation by about 0.8 and 0.9 percent over the 2021–2025 period. CBO cited PPACA's expanded eligibility for Medicaid and subsidies and tax credits that rise with income as disincentives to work, so repealing PPACA would remove those disincentives, encouraging workers to supply more labor, increasing the total number of hours worked by about 1.5% over the 2021–2025 period. Remove the higher tax rates on capital income, thereby encouraging investment, raising the capital stock and output in the long-run. In 2015 the progressive Center for Economic and Policy Research found no evidence that companies were reducing worker hours to avoid PPACA requirements for employees working over 30 hours per week. CBO estimated that PPACA would slightly reduce the size of the labor force and number of hours worked, as some would no longer be tethered to employers for their insurance. Jonathan Cohn claimed that PPACA's primary employment effect was to alleviate job lock and that the reform's only significant employment impact was the retirement of those who were working only to stay insured. Problems Though supporters employed in the policy field have hailed PPACA as successful, they have also pointed out imperfections, and have proposed changes. In 2019, economist Paul Krugman, a supporter of PPACA, wrote "The Affordable Care Act was an imperfect and incomplete reform. The political compromises needed to get it through Congress created a complex system in which too many people fall through the holes. It was also underfunded, which is why deductibles are often uncomfortably high. And the law has faced sabotage both from G.O.P.-controlled state governments and, since 2017, the Trump administration." Subsidy Cliff at 400% FPL The subsidies for an PPACA plan purchased on an exchange stop at 400% of the Federal Poverty Level (FPL). This results in a sharp "discontinuity of treatment" at 400% FPL, which is sometimes called the "subsidy cliff". People above the subsidy cliff can experience a sharp rise in premiums, making the premiums unaffordable. After-subsidy premiums for the second lowest cost silver plan (SCLSP) just below the cliff are 9.86% of income in 2019. Sometimes-Unaffordable Out-of-Pocket Maximums Under PPACA, health plans must have out-of-pocket maximums, but these can be quite high. For 2019, the highest legally permitted out-of-pocket maximum is $7,900 for an individual plan and $15,800 for a family plan, though the maximums allowed are somewhat lower for people eligible for cost-sharing reductions on the exchange. (People eligible for cost-sharing reductions are those eligible for a subsidized on-exchange plan who further have incomes between 100% and 250% of the Federal Poverty Level.) Policies may have lower out-of-pocket maximums than the legal maximum, and they tend to be lower for the more expensive higher grades of plans, like the Platinum and Gold, but they don't have to be. Family Glitch One requirement to get a subsidized on exchange health insurance plan, is to not have access to affordable employer coverage through any family member's employer, with affordable defined to be no more than 9.86% of income for just the employee's coverage). This may leave a family with no option for affordable coverage. That is, the employer coverage for the whole family, could be much