Author Topic: Impending repeal of Obamacare--what to do?  (Read 42696 times)

Zoot

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Impending repeal of Obamacare--what to do?
« on: November 09, 2016, 04:15:00 AM »
So last night, I despaired.  I was petrified.  I cried.

Today, I'm still petrified, but I seem to have activated the steely-spined pragmatist that lives within me for times such as these.

I have many questions about what to do now--on both the micro and macro scale.  The most important practical question right now, given that open enrollment ends on 11/10 for DH and 11/11 for me is what to do about health insurance.

I was ready to move to a HDP with an HSA (away from the HMO plan I've been on for a number of years).  However, given that Obamacare is likely to be repealed on Day 1 of the new Congress, I am strongly re-considering that decision. 

My belief is that everything related to pre-existing conditions will be blown away once Obamacare is repealed:  that insurers will go back to being able to DENY coverage to new customers for pre-existing conditions, and that if you are not denied coverage in general, that they can and will deny PAYING for treatments related to pre-existing conditions.

I would pay < $500/year for the HDP/HSA that I was about to sign up for through my employer.  Coverage under DH's employer with the HMO would cost about $3000/year, give or take. 

My question to you, for myself and for the many whom I'm sure are in similar situations:  is all of the above true?  Should I stay put, or go ahead and make the move?
« Last Edit: August 16, 2017, 02:09:39 PM by Zoot »

ShoulderThingThatGoesUp

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Re: Impending repeal of Obamacare--what to do?
« Reply #1 on: November 09, 2016, 04:33:23 AM »
Remember how the Democrats weren't very good at passing universal health care when they had control of Congress and the Presidency? Republicans won't be very good at repealing it. Trump isn't even an economic conservative.

KBecks

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Re: Impending repeal of Obamacare--what to do?
« Reply #2 on: November 09, 2016, 05:04:46 AM »
Take some deep breaths.   Is your health care contracted for one year, or are you able to switch whenever you want?   Take the best one for you as things are now, and then if things change, re-evaluate and cross that bridge when you get there.


slb59

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Re: Impending repeal of Obamacare--what to do?
« Reply #3 on: November 09, 2016, 05:11:23 AM »
As others have mentioned, this isn't going to disappear on January 21st. It takes time to get through legislation, and - more importantly - there are contracts and systems in place that even a unified Trump + Congress can't make disappear.

Absolute worst case scenario is that the provisions aren't there in 2018. Since they are calling for repeal and replace now, instead of the repeal of four years ago, it's pretty likely there will be something regardless. That said, the part of Obamacare you're most concerned about is pretty popular. Maybe it'll be replaced, but I can see it sticking around, too.

« Last Edit: November 09, 2016, 05:17:36 AM by slb59 »

mskyle

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Re: Impending repeal of Obamacare--what to do?
« Reply #4 on: November 09, 2016, 06:02:57 AM »
I think you're OK for next year, maybe for a couple of years. Also, generally employer-sponsored plans don't have the same rules about pre-existing conditions as plans sold on the open market (this was true pre-ACA) so if you have multiple employer plan options you're probably going to be OK for as long as that's true (I'm not clear on whether the HDP plan you're switching to is just a different plan offered by your employer or if it's actually an outside plan).

Remember how the Democrats weren't very good at passing universal health care when they had control of Congress and the Presidency? Republicans won't be very good at repealing it. Trump isn't even an economic conservative.

This, however, sounds like very wishful thinking to me - the Republicans have been promising to dismantle ACA ever since it was implemented and with control of the House, Senate, and Presidency I don't see what would stop them (filibuster, maybe). I guess if they want to do it well, that will take time, but if they just want to repeal, they will probably be able to do that pretty soon.

Malum Prohibitum

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Re: Impending repeal of Obamacare--what to do?
« Reply #5 on: November 09, 2016, 08:02:14 AM »
with control of the House, Senate, and Presidency I don't see what would stop them
  Political will - there is a big difference between talking about something and actually doing it.  For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress.  They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.

TheInsuranceMan

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Re: Impending repeal of Obamacare--what to do?
« Reply #6 on: November 09, 2016, 08:08:39 AM »
with control of the House, Senate, and Presidency I don't see what would stop them
  Political will - there is a big difference between talking about something and actually doing it.  For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress.  They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.

This, so much this.
They won't take away pre-existing coverage.  It'd be a slap in the face to the nation, and I don't see that part being repealed.  However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable.  Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked.  But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k.  Seems affordable, right?

dividendman

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Re: Impending repeal of Obamacare--what to do?
« Reply #7 on: November 09, 2016, 08:21:25 AM »
There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.

mskyle

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Re: Impending repeal of Obamacare--what to do?
« Reply #8 on: November 09, 2016, 08:31:16 AM »
with control of the House, Senate, and Presidency I don't see what would stop them
  Political will - there is a big difference between talking about something and actually doing it.  For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress.  They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.

This, so much this.
They won't take away pre-existing coverage.  It'd be a slap in the face to the nation, and I don't see that part being repealed.  However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable.  Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked.  But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k.  Seems affordable, right?

You can't have coverage for pre-existing conditions without a mandate. Otherwise any sensible person will just pay out of pocket until something expensive happens, then sign up for insurance.

ZiziPB

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Re: Impending repeal of Obamacare--what to do?
« Reply #9 on: November 09, 2016, 08:37:24 AM »
If I remember right, employer provided insurance did not have exclusions for pre-existing conditions even before ACA.



Malum Prohibitum

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Re: Impending repeal of Obamacare--what to do?
« Reply #10 on: November 09, 2016, 08:51:51 AM »
If I remember right, employer provided insurance did not have exclusions for pre-existing conditions even before ACA.
Your remember right.

BlueHouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #11 on: November 09, 2016, 08:54:03 AM »
If I remember right, employer provided insurance did not have exclusions for pre-existing conditions even before ACA.
Back when I had employer provided insurance, pre-existing conditions were covered as long as you could show proof of insurance through another insurance company.  There was also a 12-month waiting period and then all conditions were covered. 

But on private insurance, I've never seen a policy that covered pre-existing conditions with non-interupted coverage.  It had to be with the same company.   And private insurance can drop you because of a condition (new or pre-existing).  Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something.  It seems crazy, right? 

First year of ACA, I joined Kaiser and got everything that had worried me over the past 10 years checked out.  Luckily, no problems.  But I also think Kaiser is good for maintaining health and avoiding preventable illness but not so great for fixing something that is already wrong.  They do the bare minimum on certain health issues, and go beyond all expectations for weight, nutrition, stress, etc.   

I think I may change to another insurer because at my age, this is when things start to go wrong and I will want to make sure I can see the best doctors, not just who they have on staff.  And if I want a fucking mole removed, I want it removed.  I don't want someone telling me there is no medical reason to have it removed.  This mole has been sitting right under my bra strap for 10 years.  It gets irritated all the time.  Any doctor in their right mind would remove it when I explain this.  But not at kaiser.  /rant over
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soccerluvof4

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Re: Impending repeal of Obamacare--what to do?
« Reply #12 on: November 09, 2016, 09:04:12 AM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
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Dezrah

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Re: Impending repeal of Obamacare--what to do?
« Reply #13 on: November 09, 2016, 09:44:14 AM »
Honestly I'm more worried about the repeal of lifetime maximums.  Happily, $1M+ insurance bills are the exception, but heaven help you if develop a condition that requires multiple surgeries from highly skilled and highly paid specialists.  I will gladly pay higher premiums to know there is a hard ceiling I'm never going over.

HeadedWest2029

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Re: Impending repeal of Obamacare--what to do?
« Reply #14 on: November 09, 2016, 10:04:19 AM »
This was literally the first thing I Googled after I saw the election results.
For those who want to know the nuts and bolts of repealing ACA
http://www.newsweek.com/how-hard-repeal-obamacare-433590

Obviously written before election results.  Republicans don't have the 60 vote majority to close a filibuster, but budget reconciliation still seems possible.

FIFoFum

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Re: Impending repeal of Obamacare--what to do?
« Reply #15 on: November 09, 2016, 10:22:28 AM »
I too am worried about an ACA repeal via reconciliation process and subsequent denial of coverage due to pre-existing condition. This means that the only insurance I might be able to get is employer-based, so it's not just about having enough money premiums without a subsidy.

For 2017, though, you will be ok. Even if this gets pushed through the first day, the law will require a transition period. This is expected to range for 1 to 2 years depending on whether you are talking about coverage at all or ACA subsidies/Medicaid expansion. There may then be movement on state level to replace some of what's lost, though I don't expect the funding to be there. Unclear what happens to the ban on denial for pre-existing conditions at state level. Insurance markets are heavily regulated by state.

I expect we'll know more about 2018 once it is early in 2017 (February or so). Then we'll see how motivated Congress is (my guess is very!) and whether Trump will care (who knows?) about dumping health insurance for 20 million people.
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dcozad999

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Re: Impending repeal of Obamacare--what to do?
« Reply #16 on: November 09, 2016, 10:34:37 AM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.


This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.

Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #17 on: November 09, 2016, 10:44:11 AM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.


This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
But now they can, so why would they change their behavior?

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Tris Prior

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Re: Impending repeal of Obamacare--what to do?
« Reply #18 on: November 09, 2016, 01:49:02 PM »
Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something.  It seems crazy, right? 


I did the same thing for the same reason.

After Obamacare took effect, I finally sought help for my severe anxiety. Even though I was on insurance through my job at that point, I had been fearful of doing so in case I ever lost that coverage and had to go on the open market again for insurance. Now I'm kicking myself for doing that; I am in an unstable industry and I now have a mental health diagnosis on my records that, in the past, would often get you an automatic denial.

I mean, when I was getting my private insurance, they tried to deny me for *allergies*, FFS. Seasonal allergies. For which I have to take OTC meds in the late summer and fall and that's it; I don't see a doctor for them any more and haven't in 20 years.

daverobev

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Re: Impending repeal of Obamacare--what to do?
« Reply #19 on: November 09, 2016, 02:09:40 PM »
Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something.  It seems crazy, right? 


I did the same thing for the same reason.

After Obamacare took effect, I finally sought help for my severe anxiety. Even though I was on insurance through my job at that point, I had been fearful of doing so in case I ever lost that coverage and had to go on the open market again for insurance. Now I'm kicking myself for doing that; I am in an unstable industry and I now have a mental health diagnosis on my records that, in the past, would often get you an automatic denial.

I mean, when I was getting my private insurance, they tried to deny me for *allergies*, FFS. Seasonal allergies. For which I have to take OTC meds in the late summer and fall and that's it; I don't see a doctor for them any more and haven't in 20 years.

This is one thing I don't understand - how so many people are so vehemently against ACA. I'm from the UK; universal healthcare is just... just... better! It's better! Like, miles better! You don't have people not going to the doctor to get things that could be life-threatening checked because then they might not get care?

I get that the free market blah blah, but it just so blatantly isn't working *for the masses* in the US. Fuck me, everyone should get health covered, because it is better for everyone! Well, except certain biotech companies, but you know what I mean.

The saddest thing is that the people so strongly against it are the ones to benefit. That, and the fact it had to be such a shitty system in order to get past the bastards in power blocking everything else, rather than something actually sensible.

That, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".
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boarder42

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Re: Impending repeal of Obamacare--what to do?
« Reply #20 on: November 09, 2016, 02:18:16 PM »
Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something.  It seems crazy, right? 


I did the same thing for the same reason.

After Obamacare took effect, I finally sought help for my severe anxiety. Even though I was on insurance through my job at that point, I had been fearful of doing so in case I ever lost that coverage and had to go on the open market again for insurance. Now I'm kicking myself for doing that; I am in an unstable industry and I now have a mental health diagnosis on my records that, in the past, would often get you an automatic denial.

I mean, when I was getting my private insurance, they tried to deny me for *allergies*, FFS. Seasonal allergies. For which I have to take OTC meds in the late summer and fall and that's it; I don't see a doctor for them any more and haven't in 20 years.

This is one thing I don't understand - how so many people are so vehemently against ACA. I'm from the UK; universal healthcare is just... just... better! It's better! Like, miles better! You don't have people not going to the doctor to get things that could be life-threatening checked because then they might not get care?

I get that the free market blah blah, but it just so blatantly isn't working *for the masses* in the US. Fuck me, everyone should get health covered, because it is better for everyone! Well, except certain biotech companies, but you know what I mean.

The saddest thing is that the people so strongly against it are the ones to benefit. That, and the fact it had to be such a shitty system in order to get past the bastards in power blocking everything else, rather than something actually sensible.

That, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".

the ACA isnt universal healthcare its awful.  universal healthcare i'm for.
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Axecleaver

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Re: Impending repeal of Obamacare--what to do?
« Reply #21 on: November 09, 2016, 02:29:01 PM »
We have a little time. Open enrollment now, means your plan will last until 12/31/2017. Insurance plans and rates are governed at the state level by your Dept of Insurance.

The ACA will be repealed. Republicans would use budget reconciliation to counter a filibuster, and vote to de-fund. They only need 50 votes for that (with Pence providing the tie-breaker). That would break ACA by removing the APTC tax credits. And budget reconciliation debate is limited to a day, so it can't itself be filibustered.

Medicaid block grants will really hurt, too. This translates into a massive shrinking of Medicaid (less fed dollars means more state dollars , which don't exist), which will massively inflate the ranks of the uninsured. Medicaid services will be rationed in some way - shrinking the rolls, or cutting services, or both. Meanwhile, the price of services is increasing.

Over the next year, we'll know more about our options. It's too soon to panic.

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #22 on: November 09, 2016, 02:38:23 PM »
This is not going to turn out well for ERers at all.  It is a disaster.  Very upset right now.

boarder42

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Re: Impending repeal of Obamacare--what to do?
« Reply #23 on: November 09, 2016, 02:42:15 PM »
i presonally didnt like the ACA plan b/c i plan to FIRE with a larger budget than most.  hopefullly they can just put something in place thats more affordable with out the dumb subsidies.
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Re: Impending repeal of Obamacare--what to do?
« Reply #24 on: November 09, 2016, 02:48:40 PM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.


This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
There have actually been several Republicans who have published plans to replace it.  They haven't put them up for a vote because they know Obama would veto them.

MattyP

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Re: Impending repeal of Obamacare--what to do?
« Reply #25 on: November 09, 2016, 02:54:56 PM »
What are the options for healthcare without the ACA?  What do early retirees do? 

GizmoTX

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Re: Impending repeal of Obamacare--what to do?
« Reply #26 on: November 09, 2016, 03:00:24 PM »
Take some deep breaths.   Is your health care contracted for one year, or are you able to switch whenever you want?   Take the best one for you as things are now, and then if things change, re-evaluate and cross that bridge when you get there.

I happened to be seeing a doctor this am as a pre-exam for a colonoscopy. His take on replacing ACA involves providing a very basic level of care for everyone, meaning it doesn't need to include everything under the sun that is now causing premiums & deductibles to balloon & insurers to bail, and no mandate to try to force everyone to pay 'insurance' when those rates are truly unaffordable. This could be in the form of public health clinics and/or making basic Medicare accessible to the entire population. (Medicare is not free but it is affordable.) The VA might be rolled into this -- there's no need to have a separate (and unequal) set of hospitals run by the government. For those of us who need or want more extensive coverage and/or services, we'd be free to purchase supplemental insurance or concierge doctor services the same way that some of us do with Medicare.

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #27 on: November 09, 2016, 03:02:09 PM »

This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
There have actually been several Republicans who have published plans to replace it.  They haven't put them up for a vote because they know Obama would veto them.

Well, that and the fact that the replacement plans had little heft to them. Ryan's plan might even require a tax increase. How well will that go over? Are there other plans out there?

http://www.nationalreview.com/article/442019/republican-congress-president-trumps-obamacare-path-forward-what-now

Interestingly, Trump could defund the ACA on Jan 21.

Quote from: NationalReview
As I previously noted, Mr. Trump could immediately cut off these funds to insurers upon taking office.

More importantly, the ACA plans allow for their cancellation if the subsidies go away.

Quote from: NationalReview
But others have reported that the Obama administration has negotiated language in insurers’ contracts for next year allowing them to cancel plans immediately should a future Trump administration cut off insurers’ access to the cost-sharing subsidies during the middle of the 2017 plan year.

This means that any ACA plan is not guaranteed for 1 year.

Singularity

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Re: Impending repeal of Obamacare--what to do?
« Reply #28 on: November 09, 2016, 03:09:10 PM »
So last night, I despaired.  I was petrified.  I cried.

Today, I'm still petrified, but I seem to have activated the steely-spined pragmatist that lives within me for times such as these.


Nothing will realistically change until 2018.  Insurance companies were dropping out of the exchanges and premiums are increasing excessively.  This plan was sold to the US as saving the average family $2500 a year yet it failed.  Yes it did have some nice features but also some issues.

Even NYT is reporting 22% increase with some areas increasing 145%, which is clearly crazy and unsustainable long term:
http://www.nytimes.com/2016/10/26/upshot/rising-obamacare-rates-what-you-need-to-know.html



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Axecleaver

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Re: Impending repeal of Obamacare--what to do?
« Reply #29 on: November 09, 2016, 03:20:07 PM »
Quote
This means that any ACA plan is not guaranteed for 1 year
This article (thanks for that, by the way) talks about contract language between the Federal Exchange and insurers. On the surface, this appears to conflict with state Insurance Dept regs. Many folks are covered under state Exchanges, which may or may not have negotiated similar language with their insurers. Suffice to say, this is a complicated problem. And it assumes Republicans are willing to dump 21 million people off their current plan with no warning. I am not sure they've got 50 votes to do that.

Quote
What are the options for healthcare without the ACA?  What do early retirees do?
We really won't know for a while. Worst case, if you're healthy, then you can buy a policy on the open market, but without any subsidies. If you have a pre-existing condition, you will either have to return to work for insurance (assuming group plans do not exclude pre-existing conditions or subject people to a waiting period - they might), or you may be forced into a high-risk pool, with correspondingly high premiums. These existed prior to the ACA, but medical costs were a lot cheaper then, too.

It's possible that full dismantling of the ACA will take more than a year. We'll know more in the days ahead.

smoghat

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Re: Impending repeal of Obamacare--what to do?
« Reply #30 on: November 09, 2016, 03:23:39 PM »
I called up Blue Cross Friday. They had two plans available, one on the marketplace, on off. Otherwise identical.

I'm post-FIRE and 49. If the market is bad next year, I would be subsidized. If not, I won't be.

Which plan to choose?

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #31 on: November 09, 2016, 03:32:43 PM »
I called up Blue Cross Friday. They had two plans available, one on the marketplace, on off. Otherwise identical.

I'm post-FIRE and 49. If the market is bad next year, I would be subsidized. If not, I won't be.

Which plan to choose?

Subsidized. If it gets repealed without a replacement, BC/BS will probably* convert you to a non-marketplace plan or keep you on for the rest of the year.


*This is a complete WAG. Follow at your own risk.

ChpBstrd

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Re: Impending repeal of Obamacare--what to do?
« Reply #32 on: November 09, 2016, 03:33:18 PM »
Nothing changes for at least a year. More likely 2-3.

For a preview of what a one-party country will do to the ACA, look at what a one-party-state did. Arkansas replaced its "private option" program (enacted bipartisanly in 2014ish) with the more Republican-friendly "Arkansas Works" program about 2 years later. Changes were minor. A brief Republican civil war broke out between pragmatists and purists, but the bill just barely passed with help from some pork spending. Then the Republicans claimed credit for fixing the ACA and avoided the drama of kicking a quarter-million people off their plans and bankrupting most of the state's hospitals.

gillstone

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Re: Impending repeal of Obamacare--what to do?
« Reply #33 on: November 09, 2016, 04:00:27 PM »
with control of the House, Senate, and Presidency I don't see what would stop them
  Political will - there is a big difference between talking about something and actually doing it.  For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress.  They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.

This, so much this.
They won't take away pre-existing coverage.  It'd be a slap in the face to the nation, and I don't see that part being repealed.  However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable.  Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked.  But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k.  Seems affordable, right?

You keep the restrictions on the bad stuff like pre-existing conditions, lifetime caps and retroactive denial and ALSO junk the mandate.  They are part and parcel.  Those provisions are expensive and the way to pay for them is to broaden the pool by forcing everyone to have insurance.  Even if they block grant funds to state to create high-risk pools those high risk pools will be astoundingly expensive.  Cancer treatment can easily runs over $200,000.  Diabetes is a chronic condition which requires a steady stream of testing supplies and medications.

Health insurance was NOT cheap before the ACA.  Price hikes in excess of 20% were common and coverage was a patchwork if you didn't start the plan perfectly healthy.

I'm banking on Senate Democrats holding the line on any Repeal Replace BS.  The GOP is now in a position to deliver on the absurd promises they've made (Repeal ACA day 1, build a wall, balance the budget by raising spedning and cutting revenues) and I hope they choke on them.


mtnrider

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Re: Impending repeal of Obamacare--what to do?
« Reply #34 on: November 09, 2016, 05:16:30 PM »
TL;DR: Like others said, good insurance was not affordable pre-ACA.

 - In many states, individuals ran the risk of losing coverage at their first health event. 
 - Many individuals with preexisting conditions were listed as automatically uninsurable.  Insurance companies would require documentation of good health and continuous coverage.  I know someone who was denied coverage due to a note in his files reading that he was slightly depressed after a minor accident.  He was unaware of the note, until the insurance company told him about it.  One doctor had told me he wouldn't write down a very minor issue because he was concerned I would be denied coverage later.
 - Some states' regulations required that companies continue offering an insurance product to a sick individual.  Insurance companies would funnel healthy customers into other products, leaving only the sick customers in the old product, and then they'd raise the rates on the old product.
 - If you worked at a small company, the company may have been forced to drop health insurance benefits if one worker got very sick.
 - Did you forget to list a minor illness/accident when applying for coverage?  If you had a major health care event, insurance companies could claw back the payouts, claiming insurance fraud.
 - Good individual coverage generally increased pa at ridiculous rates.
 - You MAY have been able to buy some very affordable, but limited individual insurance.  But this insurance would have very low payout caps, high deductibles, and very restricted coverage.  It's OK for ER if you break your arm (once), but not if you get cancer.
 - Some states had very expensive high risk pools for uncovered residents.  They were hard to get into, and may have had a waiting list.
 - Some hospitals would give charity coverage for catastrophic health events, typically at the ED only.

Add to this:
 - Coverage for children was generally dropped at age 18.
 - If a child was in college, some regulations would allow coverage until 21.

(This list is from memory, from when I looked into it in 2007-2010 while planning FIRE, please correct me where I'm wrong.)


For those considering ER soon - this is an ideological, almost religious, disagreement about individualism vs collectivism.  Health insurance is a major risk.  Stay healthy.  And stay employed.  Or maybe, move to a state with an insurance mandate.

« Last Edit: November 09, 2016, 05:28:15 PM by mtnrider »

frugaldrummer

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Re: Impending repeal of Obamacare--what to do?
« Reply #35 on: November 09, 2016, 06:17:10 PM »
It's terrible. There IS no "Republican plan" - they would have put one forward long before now if they had one.  Their "plan" appears to be to go back to the bad old days of pre-existing condition exclusions, no requirement to buy insurance, virtually no coverage for mental health and addiction, AND to further allow crappy plans with low maximum payments to be sold across state lines to unsuspecting fools who think cancer or a bad auto accident will never happen to them. 

Many people will be trapped in their current insurance plan, so make sure the one you choose this year is the one you want to stay with.  (My son was going to drop his private Kaiser plan in favor of the inexpensive PPO offered by his work.  But now I'm concerned that he'll never be able to get back on Kaiser if he drops it, because he has some - relatively mild- preexisting conditions. )

My niece, who is adopted and was born with a severe heart defect, is a lovely and vibrant teenager.  But she will need a heart transplant eventually, probably around 30 or 35.  She'll be uninsurable when she ages off her parent's insurance.  And getting a job with a big company that offers insurance is not a solution, because her health will deteriorate to the point that she can't work LONG before she ends up on the transplant list - so any COBRA would have long since expired.  So pretty much her only option will be to remain poor enough to qualify for Medicaid for the rest of her life.

Women, if you need an IUD, do it this year before that benefit gets repealed.

Another son of mine is on a COBRA after aging off his dad's insurance (he's still in college). We chose the COBRA instead of an individual policy because the medication coverage was much better, and this son has pre-existing conditions that require some pretty expensive medications. Now, however, I have to decide this month whether to switch him to a private policy with less coverage, but that he can keep past the 18 months that the COBRA would expire.

I imagine the new Republican sham-of-a-plan will include some provision that you can't be thrown off your insurance if you've been continuously covered. There may or may not be something that says we all pay the same price per age regardless of pre-existing conditions. (In the past, people who developed serious medical conditions just faced their premiums being jacked up to three times the normal rate until they couldn't afford it.)  But they'll get rid of the mental health and addiction coverage, get rid of the mandate, won't implement any restrictions on the larcenous practices of the pharmaceutical companies (which, btw, is a big reason why your costs have been going up.  Steroid inhalers that used to cost $30 now cost $200, old cheap drugs suddenly triple or more in price because some carpet bagger cornered the market etc.  When people's day to day medications start costing more per month than their premiums it's not sustainable.  Yet Republicans voted to pass laws that keep us from negotiating drug prices.)

They'll also return to the old days when you couldn't buy insurance if you had a pre-existing condition  (leaving many people trapped in their jobs) and not covering preventive health care.

WE ARE THE ONLY RICH COUNTRY THAT DOESN'T PROVIDE HEALTH CARE TO OUR PEOPLE!  And we spend way more than anyone else on our care.

The flaws in Obamacare came from the lack of teeth in the mandate.  Where people buy insurance the costs did not go up that much.  When I divorced the COBRA on my very good plan cost $700/mo.  When that ran out I had a choice of a similar plan for $800, or a high deductible plan with HSA account for $500 a month.  This year it's $525. So over 7 years, very little increase.  It's in areas where people, fired up by anti-Obama rhetoric, refused to buy health insurance that premiums surged out of control.

Catastrophic plans sound nice but actually when they were available they saved very little over a regular plan (because most healthcare dollars go to end-of-life care).  Also many of the cheaper ones, as mentioned before, had ridiculously low caps like $250k which doesn't begin to cover a true catastrophy.  So the rest of us foot the bill in higher charges for the uninsured idiot who crashes his motorcycle and spends months in the ICU.



Cerastez

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Re: Impending repeal of Obamacare--what to do?
« Reply #36 on: November 10, 2016, 12:05:29 AM »
I am freaking out too.  I am retired, but still years from being eligible for medicare.  I retired on a relatively small nest egg so my budget is tight, and that has been fine with the ACA medical plan that I had.  I don't know how I will afford insurance and all of the ACA requirements disappearing is just awful.  I so don't want to go back to the pre-ACA world of expensive and crummy insurance.

I am going to be writing letters...lots of letters.

Metric Mouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #37 on: November 10, 2016, 12:19:29 AM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.


This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
But now they can, so why would they change their behavior?


Would the president have signed it?
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MustacheMathTM

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Re: Impending repeal of Obamacare--what to do?
« Reply #38 on: November 10, 2016, 12:25:45 AM »
I'm not FIREd yet. Planning to earn for an extra couple of years at least to offset the risks here.

Metric Mouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #39 on: November 10, 2016, 12:28:48 AM »
I'm not FIREd yet. Planning to earn for an extra couple of years at least to offset the risks here.

I'm very sorry to hear that.
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Re: Impending repeal of Obamacare--what to do?
« Reply #40 on: November 10, 2016, 03:36:23 AM »
I've been posting here for two years that my main impediment to FIRE would be health care.   I knew th3 pivotal moment would come with this election.  The worst possible case came to be.  FIRE is now postponed indefinitely.   I'm a diabetic and my oldest son a cancer survivor.   Now even though I've well funded my savings, health care will likely keep me working for years to come.  I hope people realize what they voted for.
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GrOW

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Re: Impending repeal of Obamacare--what to do?
« Reply #41 on: November 10, 2016, 03:59:21 AM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

rtrnow

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Re: Impending repeal of Obamacare--what to do?
« Reply #42 on: November 10, 2016, 06:09:22 AM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!

chasesfish

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Re: Impending repeal of Obamacare--what to do?
« Reply #43 on: November 10, 2016, 06:15:35 AM »
Take a deep breath, everything will probably be okay.

Regardless of who is in power, the country is heading down the path of some minimal level of healthcare for all.

Employers that generally support one side hate carrying the burden for insurance...
Uninsured who generally support the other hates not having insurance...

The economics of the pre-Obamacare heath plan and current obamacare health plan don't work.

I'm optimistic we'll see a medicare-light baseline plan and then give people HSAs and the ability to buy private insurance for the same quality care we see today.  I actually think having someone who's been in business and isn't beholden to special interests might make this happen.  Businesses HATE carrying the burden of insuring their employees.
« Last Edit: November 10, 2016, 06:20:43 AM by chasesfish »
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Malum Prohibitum

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Re: Impending repeal of Obamacare--what to do?
« Reply #44 on: November 10, 2016, 06:31:36 AM »
This is one thing I don't understand - how so many people are so vehemently against ACA.
  Well, Brit, maybe I am just a fucking nuts American, as you say, but I paid $450 a month for insurance with a $1500 annual deductible just a few years ago, before the ACA, to cover my entire family.  Now, I have the cheapest plan available, with a $12,500 deductible, an HSA eligible plan, meaning I pay the first $12,500 each year, and for that I pay $1026 monthly.   A plan like my old one would be over $2000 monthly.  Even my current plan is going away.  It is not available in 2017.  My insurance company can't make money at that rate.  In 2017, the absolute cheapest plan available is $1380 monthly, a 35% increase for worse coverage. It goes up from there, i.e., each plan is successively more expensive.  Comparing prices for 2017 is pretty easy, because in my geographic area, there is only one plan left, thanks to the damn ACA.

It does not take a Nobel prize in economics to realize that the premium for a person like me (inhumanly low cholesterol with good ratios, such an absurdly healthy diet that friends and family poke fun at it, and intense gym sessions 6 days a week) would rise if the government mandates that anybody else will pay the exact premium I pay, no matter their state of health, no matter the preexisting conditions.  Every fat slob with diabetes or pre-diabetes pays the same as me.  Aids patients pay the same as me.

What idiot thought that would be a good idea?

I was against the ACA before it passed, because it was blatantly obvious what was going to happen to anybody with half a brain.  Now that I have had to suffer the consequences of others' delusions for a few years, yeah, I am "vehemently against ACA."

Do you still not understand, or do you at least halfway understand, even if you somehow think this is for my own good?

Health insurance went from something I did not think about very much to a burdensome, oppressive monster.  It is by far my largest bill. 

Quote
The saddest thing is that the people so strongly against it are the ones to benefit.
  Benefit?

Quote
That, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".
  Since I used a gun when two armed robbers confronted me and my wife last year, I just have to say that maybe the one who is nuts is the one who does not recognize my or my beautiful wife's right to exist and defend our lives as we see fit.  What is "fucking nuts" about not wanting to be at the mercy of violent criminals?

Is everybody in England so blind to other points of view?

Try opening your mind a little.  There is a whole big, wide world out there.  People in that world think differently from you, and they are not "nuts" for doing so.
« Last Edit: November 10, 2016, 06:35:37 AM by Malum Prohibitum »

rtrnow

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Re: Impending repeal of Obamacare--what to do?
« Reply #45 on: November 10, 2016, 06:47:34 AM »
Quote
Every fat slob with diabetes or pre-diabetes pays the same as me.  Aids patients pay the same as me.

What idiot thought that would be a good idea?

Seriously, fuck those aids patients. I'm all for adjusting rates based on lifestyle choices like already happens with smoking, but to me its just shitty to say "well I'm blessed with good health so the hell with those that aren't." There's a lot one can do to improve their heath, but there's also a lot of genetic or just shit happens stuff out there. I'm completely willing to pay more despite my health to not bankrupt those with chronic or acute expensive conditions.

[MOD NOTE:  FYI - you might want to be a little clearer about your sarcasm, there]
« Last Edit: November 10, 2016, 02:14:43 PM by FrugalToque »

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #46 on: November 10, 2016, 06:59:57 AM »
The problem that is not being addressed is the cost of services.  It doesn't matter who pays it, single payer or private pay.  As long as the medical establishment has free reign to charge whatever they feel like we are going to keep getting extorted. 

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Re: Impending repeal of Obamacare--what to do?
« Reply #47 on: November 10, 2016, 07:07:05 AM »
- If you worked at a small company, the company may have been forced to drop health insurance benefits if one worker got very sick.

I'm terrified of this risk. I just accepted a position with a small company (I will be their 6th employee), and the only reason I was able to do so was because of the changes to health insurance laws brought about by the ACA. I have a son with spina bifida, and his health care costs tens of thousands of dollars per year. If my new employer isn't able to provide health insurance to their other employees because of my son, I will be out of a job. I was planning to buy a house in the next year, but I am seriously re-thinking whether that's a wise decision, in case I have to move again to accept a job with a larger company that could afford to insure my family.
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zhelud

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Re: Impending repeal of Obamacare--what to do?
« Reply #48 on: November 10, 2016, 07:18:00 AM »
The doctors and economists at The Incidental Economist are watching these developments closely- I highly recommend their website for good info and analysis.

http://theincidentaleconomist.com/

StarBright

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Re: Impending repeal of Obamacare--what to do?
« Reply #49 on: November 10, 2016, 07:23:56 AM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!

+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.

It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).

My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.

It is almost impossible to "shop" for procedures and especially not in the case of an emergency.

And I also +1 that Pence is *ss.