Author Topic: In case ACA is overturned, then what?  (Read 9261 times)

rayt168

  • 5 O'Clock Shadow
  • *
  • Posts: 60
  • Location: Florida
In case ACA is overturned, then what?
« on: March 11, 2019, 07:53:10 AM »
I am planning to FIRE sometime later this year.  My primary concern is the potential for ACA to be overturned if the case gets that far.  I realized there isn't much I can do about it.  One of my options is to move to another country if the ACA did get overturned.  Is anyone in a similar position?  For the people who have already FIREd, what are your plans if ACA did get overturned?  Find a job that provided health insurance?  Any thoughts? 

sol

  • Walrus Stache
  • *******
  • Posts: 8492
  • Age: 42
  • Location: Pacific Northwest
Re: In case ACA is overturned, then what?
« Reply #1 on: March 11, 2019, 08:13:05 AM »
There are approximately a hundred pages of discussion of this topic at this thread:  https://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/

If you find that too overwhelming, I'll give you the short answer.  Maybe don't worry about it too much?  The ACA isn't going anywhere in the short term, and even if it does get changed eventually we're not going back to what we had before.  There will be a new alternative plan that offers coverage at reasonable out-of-pocket costs, one way or another.

infromsea

  • Stubble
  • **
  • Posts: 106
Re: In case ACA is overturned, then what?
« Reply #2 on: March 11, 2019, 09:51:05 AM »
I work from home as a PM supporting the ACA. I work for one of the "big five" in health insurance. I'm going to keep my comments as A-political as possible, I don't have any skin in the game since I have medical coverage from military retirement so I won't comment on what's "good" and/or "bad" with regards to ACA etc.

I agree with SOL and others on the boards that something will take the place of ACA should it dissolve BUT, that's not likely.

What you might find is that some states will continue to work hard to support ACA in their states while others continue to ignore it/make it a PITA. Since ACA involves states getting to decide how they will "play in this sandbox" you see various levels of support for it.

(It's convoluted but some states run their own exchanges, some run part of the exchange, some states don't touch it and everything in that state is managed by the federal govt).

States that support ACA politically etc. continue to work hard to make it valuable, others... not so much. Where you live may become more important if health insurance is a priority and the state you want to live in doesn't support it/makes it harder to enroll.

Problems with ACA. Since it's not under-written, more and more "sick folks" are signing up. That means healthy enrollees are/and will continue to subsidize the premiums of those who are not healthy/have very low income. If you can get on an under-written policy in some way, you'll likely pay less. In addition, in some states/areas, insurers are receiving "about" .35 cents on the dollar from what they were expecting in payments from the federal govt, reducing profits and making it harder to attract quality companies in those areas. So the downward spiral (less choices, less competition, higher premiums) continues in some areas, while others have robust competition, pushing down some rates.

The future? If states get the option to opt out in the future, some of them WILL. It may be that it becomes a "play if you want to" model and folks will move to obtain health insurance in another state. Also, MEWAs (google will help) are becoming more popular and may take on some of this role.

In some states there is talk of allowing ANY group large enough to negotiate with insurers the "right" to form their own health care plan/group (AKA association plan). This MIGHT mean that if enough FIRE folks got together, they could negotiate and sell their own policy to those who are part of the group. Or, everyone in a car club, in multiple states, might be able to form a Small Group plan, things of that nature. Of course, the various sides of the issue wade in and put up roadblocks/disagree with allowing such things so they are probably a LONG ways off. I could see them "jumping off" if the ACA were to totally implode.

Lastly, the big companies are working HARD to reduce internal costs and automate as much of the filing processes as possible which MAY reduce ACA premiums (or they pocket the extra profit...). If premiums come down, more folks join, the cycle grows and it is much harder to kill ACA for good.

I know, not that helpful, but maybe a few nuggets in there.

EngagedToFIRE

  • Bristles
  • ***
  • Posts: 326
Re: In case ACA is overturned, then what?
« Reply #3 on: March 11, 2019, 11:30:06 AM »
I work from home as a PM supporting the ACA. I work for one of the "big five" in health insurance. I'm going to keep my comments as A-political as possible, I don't have any skin in the game since I have medical coverage from military retirement so I won't comment on what's "good" and/or "bad" with regards to ACA etc.

I agree with SOL and others on the boards that something will take the place of ACA should it dissolve BUT, that's not likely.

What you might find is that some states will continue to work hard to support ACA in their states while others continue to ignore it/make it a PITA. Since ACA involves states getting to decide how they will "play in this sandbox" you see various levels of support for it.

(It's convoluted but some states run their own exchanges, some run part of the exchange, some states don't touch it and everything in that state is managed by the federal govt).

States that support ACA politically etc. continue to work hard to make it valuable, others... not so much. Where you live may become more important if health insurance is a priority and the state you want to live in doesn't support it/makes it harder to enroll.

Problems with ACA. Since it's not under-written, more and more "sick folks" are signing up. That means healthy enrollees are/and will continue to subsidize the premiums of those who are not healthy/have very low income. If you can get on an under-written policy in some way, you'll likely pay less. In addition, in some states/areas, insurers are receiving "about" .35 cents on the dollar from what they were expecting in payments from the federal govt, reducing profits and making it harder to attract quality companies in those areas. So the downward spiral (less choices, less competition, higher premiums) continues in some areas, while others have robust competition, pushing down some rates.

The future? If states get the option to opt out in the future, some of them WILL. It may be that it becomes a "play if you want to" model and folks will move to obtain health insurance in another state. Also, MEWAs (google will help) are becoming more popular and may take on some of this role.

In some states there is talk of allowing ANY group large enough to negotiate with insurers the "right" to form their own health care plan/group (AKA association plan). This MIGHT mean that if enough FIRE folks got together, they could negotiate and sell their own policy to those who are part of the group. Or, everyone in a car club, in multiple states, might be able to form a Small Group plan, things of that nature. Of course, the various sides of the issue wade in and put up roadblocks/disagree with allowing such things so they are probably a LONG ways off. I could see them "jumping off" if the ACA were to totally implode.

Lastly, the big companies are working HARD to reduce internal costs and automate as much of the filing processes as possible which MAY reduce ACA premiums (or they pocket the extra profit...). If premiums come down, more folks join, the cycle grows and it is much harder to kill ACA for good.

I know, not that helpful, but maybe a few nuggets in there.

I felt your post was helpful, thank you.

I agree with the sentiment here.   "Don't worry about it too much."  It's unlikely the ACA will disappear and we'll be left with unaffordable health care.  The ACA may stick around, or maybe we'll end up with something better.  I don't think we'll end up with something worse.  I wouldn't worry too much.

Financial.Velociraptor

  • Handlebar Stache
  • *****
  • Posts: 1457
  • Age: 47
  • Location: Houston TX
  • Devour your prey raptors!
    • Financial Velociraptor
Re: In case ACA is overturned, then what?
« Reply #4 on: March 11, 2019, 02:52:12 PM »
In my early FIRE days, I let COBRA lapse assuming I could find just about any coverage since I'm largely healthy.  Turns out Tourette's syndrome that is totally under control with a $5/90 days med and hypertension combined to put me in the HOLY SHIT bucket.  No one would cover me due to pre-existing.  I settled for what they call an "indemnity plan".  It was very cheap.  It wasn't true insurance and had a lifetime cap of 5 million dollars but paid handsomely for any procedure I had done based on a flat rate schedule.  I was then free to negotiate my own price with hospitals and pocket the difference.  Best part was the IP was part of several associations that qualified for the insurance rate at most hospitals.  So I paid the discount rate, got a cash bounty that more than offset my cost of a visit and my meds, and was sufficient to cover anything short of a dread disease like Parkinson's.  You could always combine a IP with a high deductible catastrophe plan.

At any rate, alternatives already exist in the marketplace.  They will gain scale and efficiency if ACA is ever substantially repealed.  And repeal seems unlikely over next two years with a Blue House. 

My personal political opinion is Trump is about 50/50 to be re-elected.  After which by 2024 an additional 24 million millenials will be eligible to vote.  We will get a national health care plan at that point and it will be essentially impossible to overturn. 

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1192
Re: In case ACA is overturned, then what?
« Reply #5 on: March 11, 2019, 04:13:05 PM »

- SNIP -

My personal political opinion is Trump is about 50/50 to be re-elected.  After which by 2024 an additional 24 million millenials will be eligible to vote.  We will get a national health care plan at that point and it will be essentially impossible to overturn.

Looks like there is an incentive there to go out and vote in the next few election cycles.  I've always ignored this stuff, but when dying John McCain cast the vote to retain the health insurance for millions of people, it opened my eyes.

jim555

  • Handlebar Stache
  • *****
  • Posts: 2078
Re: In case ACA is overturned, then what?
« Reply #6 on: March 11, 2019, 06:12:17 PM »
My plan B is off to England until Medicare.

Hikester

  • 5 O'Clock Shadow
  • *
  • Posts: 47
Re: In case ACA is overturned, then what?
« Reply #7 on: March 13, 2019, 10:25:15 PM »
“In some states there is talk of allowing ANY group large enough to negotiate with insurers the "right" to form their own health care plan/group (AKA association plan). This MIGHT mean that if enough FIRE folks got together, they could negotiate and sell their own policy to those who are part of the group. Or, everyone in a car club, in multiple states, might be able to form a Small Group plan, things of that nature.”

I have always thought this is one way to go in order to negotiate better rates. And not to limit it to only religious affiliations. Does the right to association ring a bell?

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1192
Re: In case ACA is overturned, then what?
« Reply #8 on: March 14, 2019, 04:40:48 AM »
“In some states there is talk of allowing ANY group large enough to negotiate with insurers the "right" to form their own health care plan/group (AKA association plan). This MIGHT mean that if enough FIRE folks got together, they could negotiate and sell their own policy to those who are part of the group. Or, everyone in a car club, in multiple states, might be able to form a Small Group plan, things of that nature.”

I have always thought this is one way to go in order to negotiate better rates. And not to limit it to only religious affiliations. Does the right to association ring a bell?

Talk is just talk unless there are people behind it.  Today to make political change generally requires people with money.

infromsea

  • Stubble
  • **
  • Posts: 106
Re: In case ACA is overturned, then what?
« Reply #9 on: March 14, 2019, 04:41:17 AM »
“In some states there is talk of allowing ANY group large enough to negotiate with insurers the "right" to form their own health care plan/group (AKA association plan). This MIGHT mean that if enough FIRE folks got together, they could negotiate and sell their own policy to those who are part of the group. Or, everyone in a car club, in multiple states, might be able to form a Small Group plan, things of that nature.”

I have always thought this is one way to go in order to negotiate better rates. And not to limit it to only religious affiliations. Does the right to association ring a bell?

I think the right to association plans (and similar variants) are a possible solution but some argue that by offering choices other than the  ACA you end up with the very sick and low income on ACA, everyone else goes "somewhere else" like an association plan (if you can find one that you can join). Of course politics are at play here AND lobbying dollars are at work (non-judgmental here, just pointing out that there are multiple factors working for and against every variation possible).

I agree with earlier sentiments that the ACA was the "foot in the door" and, agree with it or not, it was the start of universal health care.

As I've aged, I've seen this "pattern" in government. When there is something that is politically "dangerous" and could get your party voted out of office, but still makes some sense, one party will enact it, the "theater of politics" occurs and they dance back and forth (most likely secretly agreeing to move forward after they've played the game long enough and can blame each other) and then things become law/routine. This seems to be how change occurs in our great country (and that's not sarcasm, this is a great country, not perfect, not the best ever in the history of time, but a great country).

I personally think universal health care will be fraught with issues BUT... how is the current system working for us? I think we have the BEST and CHEAPEST health care in the world... [sarcasm] don't get me wrong, depending on where you live, the health care options can be great [they are for me in my area] but we've screwed up when it comes to health insurance.

Why do you buy your health insurance from work/a job and not your car insurance, your cell phone plan, your light bill? The answer is risk pools. Employee groups were some of the largest groups where risk pools could be safely underwritten in a cheap manner (insurer would not lose their shirt). When we continued to grow as a country, we didn't shift and/or consider other options and now we are in the morass. The ACA may be the first attempt at a solution and it may fail but something will take it's place, as said before, once we've started on this path, something else will come up or ACA will grow and expand. 

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4612
  • Age: 11
  • Location: USA
Re: In case ACA is overturned, then what?
« Reply #10 on: March 19, 2019, 06:59:41 PM »
Really not worth fretting about. You have money, money buys options.

If it does disappear, it's not going to be gone overnight with millions of people suddenly without coverage one morning. You will get months, if not years, of advance notice.

Every time a door closes, another window opens. Something will be there.

Larsg

  • Stubble
  • **
  • Posts: 125
Re: In case ACA is overturned, then what?
« Reply #11 on: April 14, 2019, 02:29:16 AM »
I think people really have to take their health into their own hands with the exception of eye care, dentistry where insurance is pretty affordable and dentists can be competitive in pricing if you do your research, and catastrophic insurance coverage. Most all else other than accidents seem to be a huge Ponzi scheme by which Masses of people are overdosed with pills for every ailment that modern medicine can dream up then health winds up getting worse. For example, there is a new documentary on AMZN (Can't remember which one so you just have to check out the newest offerings) that shows how the industry behind high cholesterol has been dead wrong - that we actually need cholesterol, our heart needs it, our bones and teeth need it...they need fats. And, like cancer, it shows that there has not been all that much improvement in longevity with cholesterol lowering drugs - due to the fact that it wasn't about the cholesterol but other health related problems - Sugar consumption seems to be a key root cause to most ailments vs cholesterol or fats.

Cancer - "There is no money in the cure" -- Eddie Murphy...research here has also been stunning where few real improvements have happened since the 70's but the profits of Big Pharma has grown exponentially. You can do your own research on how many women have died because of unnessisary treatments due to mammograms turning up things that might or might not be cancer and put patience through Chemo and Radiation just to be safe and then they wind up getting cancer due to those treatments. The findings have been that mammograms have not really saved any more lives and have probably cost more than saved. For the guys, there is a similar issue with false positives of Urine Tests finding protein levels that indicate cancer - I have a couple friends that have gone in for biopsies and found they were nothing but there seems to be a high number of false positives according to a book below. This kind of surgery can then cause an infection that can cause kidney failure or kill you - see book below that covers some stunning stats.

There is a great book by a doctor on these topics called Coyote Medicine from a young American Indian Doctor's journey through the medical system and what he learned about it - just horrifying. https://www.amazon.com/Coyote-Medicine-Lessons-American-Healing-ebook/dp/B004CLYL3K/ref=dp_kinw_strp_1

I've seen first hand the promise of more life in exchange for all of the individuals remaining wealth...and then after handing over their money, they live for a few more months while suffering terribly, barely coherent with their families in anguish, denial, or chasing false hope until the end.

Insurance should be used for the big stuff vs eery ailment that can be dreamed up "as a service" by the Wealth Transfer Mafia that is healthcare.

We must take control of our diets, exercise, get fresh air, good filtered water, ensure you and your kids are getting foods with Vitamin K (which includes BUTTER) feed the mind and soul good stuff and not live our whole lives for the last five years of it so that we'll have good insurance....that's insanity.

In the mean time, high deductible insurance, HSA Max Out, Catastrophic Insurance (not that expensive), Take good care of yourself and kids - especially the teeth (big relationship between heath of teeth, heart, and all else, get life insurance in case things don't go your way to take care of those left behind if you have family, and we all must develop the courage to face down end of life in a dignified way - easier said than done I know - including living in a "right to die" state where you have the choice to make the call so that you can pass where and with who and when you are ready vs becoming someone else science project in exchange for your bank account.

Finally, here is an excellent article from Hillsdale college on The History of Health Insurance: https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

and https://imprimis.hillsdale.edu/health-care-in-a-free-society/





pecunia

  • Handlebar Stache
  • *****
  • Posts: 1192
Re: In case ACA is overturned, then what?
« Reply #12 on: April 14, 2019, 09:18:06 AM »
- SNIP -

We must take control of our diets, exercise, get fresh air, good filtered water, ensure you and your kids are getting foods with Vitamin K (which includes BUTTER) feed the mind and soul good stuff and not live our whole lives for the last five years of it so that we'll have good insurance....that's insanity.

In the mean time, high deductible insurance, HSA Max Out, Catastrophic Insurance (not that expensive), Take good care of yourself and kids - especially the teeth (big relationship between heath of teeth, heart, and all else, get life insurance in case things don't go your way to take care of those left behind if you have family, and we all must develop the courage to face down end of life in a dignified way - easier said than done I know - including living in a "right to die" state where you have the choice to make the call so that you can pass where and with who and when you are ready vs becoming someone else science project in exchange for your bank account.

Finally, here is an excellent article from Hillsdale college on The History of Health Insurance: https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

and https://imprimis.hillsdale.edu/health-care-in-a-free-society/

Most of this seems like good advice - I would be leery of anything produced by Hillsdale College.

I was taking a walk yesterday and stopped at a park.  there was a sign that said,"No Smoking Beyond This Point."  There wasn't much after that point so I happened to mention it and mutter half to myself.  A woman nearby said it's like that in hospitals too.  Not much relief from the smoke.  I asked if she worked in a hospital and she replied in the affirmative.  I then asked what she thought about this health insurance thing.  She said it was a big scam  Even the people who work with it are not defending it any more.

You know I don't think I've ever seen an ad for preventive medicine on TV.

FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #13 on: April 14, 2019, 01:32:55 PM »
- SNIP -

We must take control of our diets, exercise, get fresh air, good filtered water, ensure you and your kids are getting foods with Vitamin K (which includes BUTTER) feed the mind and soul good stuff and not live our whole lives for the last five years of it so that we'll have good insurance....that's insanity.

In the mean time, high deductible insurance, HSA Max Out, Catastrophic Insurance (not that expensive), Take good care of yourself and kids - especially the teeth (big relationship between heath of teeth, heart, and all else, get life insurance in case things don't go your way to take care of those left behind if you have family, and we all must develop the courage to face down end of life in a dignified way - easier said than done I know - including living in a "right to die" state where you have the choice to make the call so that you can pass where and with who and when you are ready vs becoming someone else science project in exchange for your bank account.

Finally, here is an excellent article from Hillsdale college on The History of Health Insurance: https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

and https://imprimis.hillsdale.edu/health-care-in-a-free-society/

Most of this seems like good advice - I would be leery of anything produced by Hillsdale College.

I was taking a walk yesterday and stopped at a park.  there was a sign that said,"No Smoking Beyond This Point."  There wasn't much after that point so I happened to mention it and mutter half to myself.  A woman nearby said it's like that in hospitals too.  Not much relief from the smoke.  I asked if she worked in a hospital and she replied in the affirmative.  I then asked what she thought about this health insurance thing.  She said it was a big scam  Even the people who work with it are not defending it any more.

You know I don't think I've ever seen an ad for preventive medicine on TV.

I worked in a hospital in the past, and they didn't allow smoking in the hospital, even 20 years prior, and later disallowed it anywhere on the hospital grounds.  Maybe there are some hospitals that still allow it, but I haven't been to any that do.

It sounds like Larsg doesn't believe in the science of medicine and all of the lives saved.  Living a healthy lifestyle and taking advantage of modern medicine when needed are not mutually exclusive.  Many people have expensive healthcare expenses through no fault of their own.

It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

And for those who think that something else or something better will replace it, that would most likely take years, beyond the the next election cycle.  In the meantime, you need healthcare insurance.  Living a healthy lifestyle is not insurance!

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1192
Re: In case ACA is overturned, then what?
« Reply #14 on: April 14, 2019, 06:33:26 PM »


I worked in a hospital in the past, and they didn't allow smoking in the hospital, even 20 years prior, and later disallowed it anywhere on the hospital grounds.  Maybe there are some hospitals that still allow it, but I haven't been to any that do.

It sounds like Larsg doesn't believe in the science of medicine and all of the lives saved.  Living a healthy lifestyle and taking advantage of modern medicine when needed are not mutually exclusive.  Many people have expensive healthcare expenses through no fault of their own.

It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

And for those who think that something else or something better will replace it, that would most likely take years, beyond the the next election cycle.  In the meantime, you need healthcare insurance.  Living a healthy lifestyle is not insurance!

They tried to repeal it in the Spring of 2017.  There was quite the public outcry.  The GOP had the majority in the House at the time.  They were going to replace it with a garbage bill.  John McCain came through and saved the day.  It sure opened my eyes.  I had always thought that politicians in Congress were on the side of the public.

I think there would be an equal outcry today.  With the talk of Medicare for All and some good public support, I think there will be some compromises made and the ACA will be improved.  There would be repercussions if they took away the health insurance from millions of people.  It will be an evolutionary change  rather than a revolutionary change, but it will move towards what the rest of the Western world has.

Bateaux

  • Handlebar Stache
  • *****
  • Posts: 1488
  • Location: Port Vincent
Re: In case ACA is overturned, then what?
« Reply #15 on: April 19, 2019, 12:42:21 PM »
I've made my decision that I'm not going to FIRE prior to the 2020 elections.  John McCain bought us some time.   The 2018 midterms solidified that.  There isn't a poll in the world I'd trust with the 2020 elections.   If the Republicans take back all branches of government again, I'm postponing FIRE till 2023.  That's when I'm eligible for company retirement healthcare.   I don't have good family genetics and I've had a lifetime of exposure to carcinogens on the job.  Not so much now as in the past.  It wouldn't be right for me to get sick and bankrupt my family.

FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #16 on: April 20, 2019, 12:59:14 PM »


I worked in a hospital in the past, and they didn't allow smoking in the hospital, even 20 years prior, and later disallowed it anywhere on the hospital grounds.  Maybe there are some hospitals that still allow it, but I haven't been to any that do.

It sounds like Larsg doesn't believe in the science of medicine and all of the lives saved.  Living a healthy lifestyle and taking advantage of modern medicine when needed are not mutually exclusive.  Many people have expensive healthcare expenses through no fault of their own.

It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

And for those who think that something else or something better will replace it, that would most likely take years, beyond the the next election cycle.  In the meantime, you need healthcare insurance.  Living a healthy lifestyle is not insurance!

They tried to repeal it in the Spring of 2017.  There was quite the public outcry.  The GOP had the majority in the House at the time.  They were going to replace it with a garbage bill.  John McCain came through and saved the day.  It sure opened my eyes.  I had always thought that politicians in Congress were on the side of the public.

I think there would be an equal outcry today.  With the talk of Medicare for All and some good public support, I think there will be some compromises made and the ACA will be improved.  There would be repercussions if they took away the health insurance from millions of people.  It will be an evolutionary change  rather than a revolutionary change, but it will move towards what the rest of the Western world has.

When I mentioned that it wasn't looking good for the ACA, I meant the lawsuit in which it was already ruled unconstitutional.  That could be overruled by an appeals court (not likely) or eventually SCOTUS (maybe, but not for another year or two).  It's not going to be repealed under the current Congress.  If the unconstitutionality ruling is upheld, something may eventually replace it, but it may not be as good, and it could take years, where we are back to where we used to be with no subsidies, no medicaid expansion, and none of the protections that we have under the ACA.....  for years, especially if the democrats alone don't have the majorities to push a decent healthcare plan through after the next election cycle.  Relying on the future possibility of a quick replacement to the ACA looks like a long shot, so the best hope now is that the ACA is upheld by the courts.  I'm certainly hoping so.

I've made my decision that I'm not going to FIRE prior to the 2020 elections.  John McCain bought us some time.   The 2018 midterms solidified that.  There isn't a poll in the world I'd trust with the 2020 elections.   If the Republicans take back all branches of government again, I'm postponing FIRE till 2023.  That's when I'm eligible for company retirement healthcare.   I don't have good family genetics and I've had a lifetime of exposure to carcinogens on the job.  Not so much now as in the past.  It wouldn't be right for me to get sick and bankrupt my family.

I feel your pain.  I don't even have a home waiting for me in Florida to move into, but I still hate to delay FIRE.  It will will be tough to go ahead and FIRE if the ACA ruling is upheld, that it's unconstitutional.   I've only got 1.4M in stash hoping to FIRE next year as a single guy in my mid 50's, so it would be painful to FIRE without ACA subsides.  Despite having a history of good health and low medical expenses, I wouldn't risk going without insurance.

John Galt incarnate!

  • Bristles
  • ***
  • Posts: 472
Re: In case ACA is overturned, then what?
« Reply #17 on: April 20, 2019, 05:42:08 PM »

I am planning to FIRE sometime later this year.  My primary concern is the potential for ACA to be overturned if the case gets that far. 

 Any thoughts?

The general rule of courts' statutory construction is that they exercise judicial restraint and strive to interpret a statute such that it is in conformity with the Constitution. There is virtually no possibility that the Supreme Court of the United States will sustain a lower court's overturning of the ACA. Of course this also means that the high Court itself will never overturn the ACA.





Lochner v. New York (1905)


"But it is equally true -- indeed, the public interests imperatively demand -- that legislative enactments should be recognized and enforced by the courts as embodying the will of the people unless they are plainly and palpably, beyond all question, in violation of the fundamental law of the Constitution." Justice Harlan (Dissent)



National Labor Relations Board v. Jones & Laughlin Steel Corporation
(1937)


 "The cardinal principle of statutory construction is to save, and not to destroy. We have repeatedly held that, as between two possible interpretations of a statute, by one of which it would be unconstitutional and by the other valid, our plain duty is to adopt that which will save the act. Even to avoid a serious doubt, the rule is the same." Chief Justice Charles Evans Hughes
« Last Edit: April 20, 2019, 05:48:32 PM by John Galt incarnate! »

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1192
Re: In case ACA is overturned, then what?
« Reply #18 on: April 20, 2019, 06:29:54 PM »
When Obamacare was put in, it was examined by the Supreme Court.  Barack Obama himself was quite the constitutional scholar.  A similar thing had been used in Massachusetts for years.

This link says any legal battles will drag on.

https://www.apnews.com/fbc3395b65c54756882e4ce5cabfe72b

The pendulum is swinging against the current system of US health care.  I have discussed this with random people of all political persuasions.  Nobody is satisfied with what we have now.  I think the ACA will either be improved or replaced with something even better, but I'm not holding my breath.  There could be an interim period where parts of it are struck down in some manner getting us burned.

It looks like it is good for a few years and the pendulum is swinging towards the party that wants to improve it.

If the ACA is struck down, many Mustachians may go back to work.

FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #19 on: April 20, 2019, 08:16:55 PM »
If the ACA is struck down, many Mustachians may go back to work.

Or in my case and many mustachians, KEEP WORKING instead of FIREing hoping that eventually something comes along that's affordable and provides decent coverage before reaching Medicare age.

The article you linked to talks about the lawsuit and ruling I was referring to, and it speaks about that real possibility of the whole ACA being thrown out.  This could drag out longer than my one year FIRE target, and I need to make a decision at least a month before my last day.

John Galt incarnate!

  • Bristles
  • ***
  • Posts: 472
Re: In case ACA is overturned, then what?
« Reply #20 on: April 22, 2019, 07:54:39 PM »


It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

The polity's reliance on a statute or legislation is among the disparate factors  the Supreme Court of the  United States will evaluate if it  considers overruling its prior decision.  The ubiquitous  and continuing reliance on the ACA to provide a great variety of medical care  is immediately  obvious. The Court's cognizance of this reliance would lead to its ineluctable conclusion  that it is a "kind of reliance that would lend a special hardship to the consequences of overruling."

Planned Parenthood of Southeastern Pennsylvania v. Casey (1992)


"The inquiry into reliance counts the cost of a rule's repudiation as it would fall on those who have relied reasonably on the rule's continued application."


All of the above militates  resoundingly against the high Court  overruling the ACA.
 

« Last Edit: April 22, 2019, 08:10:22 PM by John Galt incarnate! »

FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #21 on: April 22, 2019, 08:15:16 PM »

It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

The polity's reliance on a statute or legislation is among the disparate factors  the Supreme Court of the  United States will evaluate if it  considers overruling its prior decision.  The ubiquitous  and continuing reliance on the ACA to provide a great variety of medical care  is immediately  obvious. The Court's cognizance of this reliance would lead to its ineluctable conclusion  that it is a "kind of reliance that would lend a special hardship to the consequences of overruling."

Planned Parenthood of Southeastern Pennsylvania v. Casey (1992)


"The inquiry into reliance counts the cost of a rule's repudiation as it would fall on those who have relied reasonably on the rule's continued application."

All of the above militates  resoundingly against the high Court  overruling the ACA.

I actually made that post on April 14th, not the 20th.  But no one knows what will happen.

John Galt incarnate!

  • Bristles
  • ***
  • Posts: 472
Re: In case ACA is overturned, then what?
« Reply #22 on: April 22, 2019, 08:44:56 PM »

It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

The polity's reliance on a statute or legislation is among the disparate factors  the Supreme Court of the  United States will evaluate if it  considers overruling its prior decision.  The ubiquitous  and continuing reliance on the ACA to provide a great variety of medical care  is immediately  obvious. The Court's cognizance of this reliance would lead to its ineluctable conclusion  that it is a "kind of reliance that would lend a special hardship to the consequences of overruling."

Planned Parenthood of Southeastern Pennsylvania v. Casey (1992)


"The inquiry into reliance counts the cost of a rule's repudiation as it would fall on those who have relied reasonably on the rule's continued application."

All of the above militates  resoundingly against the high Court  overruling the ACA.

I actually made that post on April 14th, not the 20th.  But no one knows what will happen.

Sorry for the wrong date.









FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #23 on: April 23, 2019, 04:30:19 PM »

It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

The polity's reliance on a statute or legislation is among the disparate factors  the Supreme Court of the  United States will evaluate if it  considers overruling its prior decision.  The ubiquitous  and continuing reliance on the ACA to provide a great variety of medical care  is immediately  obvious. The Court's cognizance of this reliance would lead to its ineluctable conclusion  that it is a "kind of reliance that would lend a special hardship to the consequences of overruling."

Planned Parenthood of Southeastern Pennsylvania v. Casey (1992)


"The inquiry into reliance counts the cost of a rule's repudiation as it would fall on those who have relied reasonably on the rule's continued application."

All of the above militates  resoundingly against the high Court  overruling the ACA.

I actually made that post on April 14th, not the 20th.  But no one knows what will happen.

Sorry for the wrong date.

No problem.  And I hope you're right about the Court and ACA.

John Galt incarnate!

  • Bristles
  • ***
  • Posts: 472
Re: In case ACA is overturned, then what?
« Reply #24 on: April 24, 2019, 08:09:56 AM »

It's not looking good for the ACA.  There looks to be some wishful thinking by some earlier posters, but the odds are against it.

The polity's reliance on a statute or legislation is among the disparate factors  the Supreme Court of the  United States will evaluate if it  considers overruling its prior decision.  The ubiquitous  and continuing reliance on the ACA to provide a great variety of medical care  is immediately  obvious. The Court's cognizance of this reliance would lead to its ineluctable conclusion  that it is a "kind of reliance that would lend a special hardship to the consequences of overruling."

Planned Parenthood of Southeastern Pennsylvania v. Casey (1992)


"The inquiry into reliance counts the cost of a rule's repudiation as it would fall on those who have relied reasonably on the rule's continued application."

All of the above militates  resoundingly against the high Court  overruling the ACA.

I actually made that post on April 14th, not the 20th.  But no one knows what will happen.

Sorry for the wrong date.

No problem.  And I hope you're right about the Court and ACA.



The Supreme Court will be exceedingly circumspect if it decides to hear arguments aimed at  overruling  the ACA.

Within the next week or so I'll be posting more in this thread about the constellation of considerations that guide the  Court when stare decisis is at issue.

Why the high Court rules as it  does, its  rationale for determining whether legislation is constitutional or not,   is my favorite subject matter  when discussing constitutional law.
« Last Edit: May 04, 2019, 02:03:41 PM by John Galt incarnate! »

FIRE@50

  • Pencil Stache
  • ****
  • Posts: 518
  • Age: 41
  • Location: Maryland
Re: In case ACA is overturned, then what?
« Reply #25 on: April 24, 2019, 09:37:36 AM »
If the ACA is struck down, many Mustachians may go back to work.

Or in my case and many mustachians, KEEP WORKING instead of FIREing hoping that eventually something comes along that's affordable and provides decent coverage before reaching Medicare age.

The article you linked to talks about the lawsuit and ruling I was referring to, and it speaks about that real possibility of the whole ACA being thrown out.  This could drag out longer than my one year FIRE target, and I need to make a decision at least a month before my last day.
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use. If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

Besides, isn't everyone maxing out their HSA?

mtnrider

  • Bristles
  • ***
  • Posts: 318
  • Location: Frozen tundra in the Northeast
Re: In case ACA is overturned, then what?
« Reply #26 on: April 24, 2019, 01:04:26 PM »
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use. If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

Besides, isn't everyone maxing out their HSA?

This seems a short-sighted analysis.  Define "use".

Is the ACA something you won’t use?  Perhaps.  See also auto insurance.  Or social security.  Or ...

As has been discussed in other threads, the ACA is 1) a group discount; 2) insurance against medical bills that would bankrupt you - a risk mitigator; and 3) a cost sharing from the most expensive group to the least - older people, pregnant women, those who lost the DNA lottery.

For preventative measures, with enough time you can probably negotiate a better discount.  But without the ACA, good luck getting insurance on a preexisting condition or covering expensive emergency bills.  A healthy guy I know had a heart attack in his late 50s.  The cost, pre-ACA, was over half a million dollars.  That’d take a healthy bite out of your FI stash.  Another young guy became uninsurable due to a previously undetected minor heart defect that had caused a stroke while weight lifting.


FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #27 on: April 24, 2019, 03:35:52 PM »
If the ACA is struck down, many Mustachians may go back to work.

Or in my case and many mustachians, KEEP WORKING instead of FIREing hoping that eventually something comes along that's affordable and provides decent coverage before reaching Medicare age.

The article you linked to talks about the lawsuit and ruling I was referring to, and it speaks about that real possibility of the whole ACA being thrown out.  This could drag out longer than my one year FIRE target, and I need to make a decision at least a month before my last day.
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use.

Are you serious??  Going without insurance or some type of paid healthcare coverage is very risky, even when you are healthy.

Quote
If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

There's a huge downside.  I can get subsidized healthcare insurance with protections through the ACA much less expensive than without it.   And regarding that part of it being replaced by "government healthcare, I have two responses.  One, there could be period of years for that to ever happen, if it ever does.  And it won't necessarily cost you almost "nil".   Look at what people are currently still paying for Medicare parts B, D, and supplemental after paying into it for 40 years.

Quote
Besides, isn't everyone maxing out their HSA?

You have to have a qualifying plan.  Many people such as myself have a very low deductible healthcare plan and don't qualify for HSA.

Acastus

  • Bristles
  • ***
  • Posts: 367
  • Age: 57
Re: In case ACA is overturned, then what?
« Reply #28 on: May 03, 2019, 03:20:09 PM »
I live in NY, so my fall back is Massachusetts or Ontario. I think my stash is big enough that I can become Canadian as an investor.

stoaX

  • Pencil Stache
  • ****
  • Posts: 517
  • Location: SoCal
  • 'tis nothing good nor bad but thinking makes it so
Re: In case ACA is overturned, then what?
« Reply #29 on: May 03, 2019, 03:29:17 PM »
If the ACA is struck down, many Mustachians may go back to work.


There's a huge downside.  I can get subsidized healthcare insurance with protections through the ACA much less expensive than without it.   And regarding that part of it being replaced by "government healthcare, I have two responses.  One, there could be period of years for that to ever happen, if it ever does.  And it won't necessarily cost you almost "nil".   Look at what people are currently still paying for Medicare parts B, D, and supplemental after paying into it for 40 years.

Quote



When the ACA was passed in 2010 it wasn't until 2014 that the first individual plans became available.  So yeah, the comment about a replacement for the ACA taking years to become operational is spot on.

MandalayPA

  • 5 O'Clock Shadow
  • *
  • Posts: 29
  • Location: Pittsburgh, PA
  • The Artist Formerly Known as MandalayVA
Re: In case ACA is overturned, then what?
« Reply #30 on: May 04, 2019, 01:17:12 PM »
Another reason that we chose to move to Pittsburgh is that its main hospital, UPMC, offers health insurance on its own and is competitive with the local Blue Cross Blue Shield carrier, Highmark.  Also, Pennsylvania has indicated that it would be willing to have a state-run exchange should the ACA go poof.  Our premiums are literally half of what they were in Florida.

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4982
  • Age: 34
  • Location: Seattle, WA
    • My blog
Re: In case ACA is overturned, then what?
« Reply #31 on: May 04, 2019, 03:19:45 PM »
I live in NY, so my fall back is Massachusetts or Ontario. I think my stash is big enough that I can become Canadian as an investor.


Most of Canada got rid of their investor visa a few years ago, but Quebec still has one. The terms of the "investment" aren't very favorable...it's basically a five-year interest-free loan to the Quebec government in the amount of CA$1.2 million.

Other immigrant investor visas still available include Ireland (required investment: option of €1 million in Irish businesses or €2 million in Irish REITs or €500k charitable donation), the UK (required investment: £2 million), and New Zealand (required investment: NZ$3 million).

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4612
  • Age: 11
  • Location: USA
Re: In case ACA is overturned, then what?
« Reply #32 on: May 05, 2019, 09:31:32 AM »
Spain: 500k EUR in real estate (can be primary residence).

All of these programs are likely to undergo some changes soon, because the EU isn't taking too kindly to Malta and Cyprus selling access to Russian oligarchs.

Spitfire

  • Bristles
  • ***
  • Posts: 268
  • Location: Weston, FL
Re: In case ACA is overturned, then what?
« Reply #33 on: May 06, 2019, 09:51:08 AM »
From what I read I like the direct primary care model and hope it gains traction. No insurance, under $100/month, and can handle most of your care. Pair that with a catastrophic plan in case something truly terrible happens. Could be a cost effective way to do things.

CindyBS

  • Bristles
  • ***
  • Posts: 451
Re: In case ACA is overturned, then what?
« Reply #34 on: May 06, 2019, 06:30:17 PM »
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use. If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

Besides, isn't everyone maxing out their HSA?


Our family has had $2.5 Million of medical expenses in the last 3 years - all for a condition that was NOT pre-existing and we had no family history.  Before my son got sick our insurance was something we "didn't use" either.


We've maxed out our HSA for years - don't kid yourself on how absolutely catastrophically expensive an illness can be.  Very few people could have covered our medical expenses from an HSA and their entire net worth.

Also you completely neglect the protections of the ACA like prohibitions against lifetime maxes (which we would have hit), prohibitions on denying coverage based on pre-exisiting conditions, being able to stay on your parents' insurance until age 26 - all of which are the only things keeping my son insurable.  A huge downside for us if the ACA is overturned.

Much Fishing to Do

  • Pencil Stache
  • ****
  • Posts: 531
Re: In case ACA is overturned, then what?
« Reply #35 on: May 07, 2019, 09:22:05 AM »
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use. If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

Besides, isn't everyone maxing out their HSA?


Our family has had $2.5 Million of medical expenses in the last 3 years - all for a condition that was NOT pre-existing and we had no family history.  Before my son got sick our insurance was something we "didn't use" either.


We've maxed out our HSA for years - don't kid yourself on how absolutely catastrophically expensive an illness can be.  Very few people could have covered our medical expenses from an HSA and their entire net worth.

Also you completely neglect the protections of the ACA like prohibitions against lifetime maxes (which we would have hit), prohibitions on denying coverage based on pre-exisiting conditions, being able to stay on your parents' insurance until age 26 - all of which are the only things keeping my son insurable.  A huge downside for us if the ACA is overturned.

That reminds me of what I've seem to think about pharmaceuticals and healthcare in the past, esp. when the ACA came up (and now maybe college tuition, and maybe other things will follow) where the price will often basically become "whatdaya got?", which in a way is what the ACA subsidies is figuring out big picture.  I think we'll keep moving to and stay at a place where necessary healthcare will not be denied to those who literally cannot pay, as the alternative seems like such a politically dangerous position for the healthcare industry to be in at this point, when there is still plenty of money to be made and given (well, I guess mainly for pharmaceuticals) there is little marginal cost to providing more drugs for more people, so it seems the logical place to be for them, as in the end you'll only recover however much money is out there to give and no more.  It kinda already seemed this way in many local hospitals (in my experience they are very "forgiving" when you can't pay a bill, 25 years ago I couldnt afford a $2k bill they sent me and they took the $15/mth I sent them and I never heard from them, they never sent me to collections or contacted a credit agency, and years later when I had the money I paid it off without interest and they sent a paid in full thank you).

No political point (like many folks I can come up with countless ways to fix it but know the unintended consequences could also be countless with each) and I don't know enough about it to defend this well, just anecdotally to me this seems to be whats happening.  Its kinda a way to achieve what a single payer system would do having those that have more pay for those that have less, but of course in a very different and not cleanly or perfectly in any way.


happychineseboy

  • 5 O'Clock Shadow
  • *
  • Posts: 18
  • Age: 29
Re: In case ACA is overturned, then what?
« Reply #36 on: May 10, 2019, 07:26:24 AM »
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use. If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

Besides, isn't everyone maxing out their HSA?


Our family has had $2.5 Million of medical expenses in the last 3 years - all for a condition that was NOT pre-existing and we had no family history.  Before my son got sick our insurance was something we "didn't use" either.


We've maxed out our HSA for years - don't kid yourself on how absolutely catastrophically expensive an illness can be.  Very few people could have covered our medical expenses from an HSA and their entire net worth.

Also you completely neglect the protections of the ACA like prohibitions against lifetime maxes (which we would have hit), prohibitions on denying coverage based on pre-exisiting conditions, being able to stay on your parents' insurance until age 26 - all of which are the only things keeping my son insurable.  A huge downside for us if the ACA is overturned.


I am curious what condition results in $2.5 million in expenses, do you mind sharing?

mtnrider

  • Bristles
  • ***
  • Posts: 318
  • Location: Frozen tundra in the Northeast
Re: In case ACA is overturned, then what?
« Reply #37 on: May 10, 2019, 08:41:26 AM »
Our family has had $2.5 Million of medical expenses in the last 3 years - all for a condition that was NOT pre-existing and we had no family history.  Before my son got sick our insurance was something we "didn't use" either.

I am curious what condition results in $2.5 million in expenses, do you mind sharing?

Not CindyBS.  But a relatively routine heart surgery is over half a million, mostly due to the hospital stay with a stint in the ICU.  So if you're unlucky and have a few major surgeries that require a week long hospital stays for each one... well, you can do the math.


DaMa

  • Stubble
  • **
  • Posts: 211
Re: In case ACA is overturned, then what?
« Reply #38 on: May 10, 2019, 08:56:07 AM »
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use. If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

Besides, isn't everyone maxing out their HSA?


Our family has had $2.5 Million of medical expenses in the last 3 years - all for a condition that was NOT pre-existing and we had no family history.  Before my son got sick our insurance was something we "didn't use" either.


We've maxed out our HSA for years - don't kid yourself on how absolutely catastrophically expensive an illness can be.  Very few people could have covered our medical expenses from an HSA and their entire net worth.

Also you completely neglect the protections of the ACA like prohibitions against lifetime maxes (which we would have hit), prohibitions on denying coverage based on pre-exisiting conditions, being able to stay on your parents' insurance until age 26 - all of which are the only things keeping my son insurable.  A huge downside for us if the ACA is overturned.


I am curious what condition results in $2.5 million in expenses, do you mind sharing?

Not CindyBS.  Recurrent Hodgkin's Lymphoma with a stem cell transplant was about $1 million over 18 months 10 years ago, and the only surgery was a biopsy.  Totally random disease in healthy 19 year old, pre-ACA.

sol

  • Walrus Stache
  • *******
  • Posts: 8492
  • Age: 42
  • Location: Pacific Northwest
Re: In case ACA is overturned, then what?
« Reply #39 on: May 10, 2019, 09:03:20 AM »
Not CindyBS.  But a relatively routine heart surgery is over half a million, mostly due to the hospital stay with a stint in the ICU.

Not CindyBS.  Recurrent Hodgkin's Lymphoma with a stem cell transplant was about $1 million over 18 months 10 years ago, and the only surgery was a biopsy.  Totally random disease in healthy 19 year old, pre-ACA.

The US healthcare system, coming in hot.

America, Fuck Yea!  WE'RE NUMBER ONE!  WE'RE NUMBER ONE!  C'mon guys, let's get a stadium chant going.  I think I hear a bald eagle crying.

BTDretire

  • Magnum Stache
  • ******
  • Posts: 2680
Re: In case ACA is overturned, then what?
« Reply #40 on: May 10, 2019, 10:56:28 AM »

Problems with ACA. Since it's not under-written, more and more "sick folks" are signing up. That means healthy enrollees are/and will continue to subsidize the premiums of those who are not healthy/have very low income. If you can get on an under-written policy in some way, you'll likely pay less. In addition, in some states/areas, insurers are receiving "about" .35 cents on the dollar from what they were expecting in payments from the federal govt, reducing profits and making it harder to attract quality companies in those areas

 You hit it with the above statement, I have an underwritten policy (I assume that is most any policy that is not Obamacare) I have a standard BCBS policy that was grandfathered in.
 I pay $12,200 for my family of 4 and both parents are older nearing SS. (age raises the price)
When I look up the subsidy for an ACA policy it is $28,303 for a family of 4 (ages same as mine) making $50,000.
 That means the ACA policy is costing everyone 2.3 time more than a private policy.
(it could be more, that is only the subsidy amount, I don't know if the family has to pay anything.)
 It gets worse, those numbers for a low cost area, some zip codes have a much higher subsidy.
 If you make $100,000 the subsidy drops to $21,696.
 The whole thing seems it was done all wrong.
 The government program raised the price of insurance then gives money to high income earners to pay that premium.
We should have just picked those truly needy and bought them insurance.

If you want to look it up F 64, M 60, D 27, S 24yrs old. non smokers, zip 32401.
 Then adjust income from $50k up to $100k in increments of $10k.
Challenge find a high cost area and compare. ( I had a high cost zip but have lost track of it.)
Somewhere inland of the East coast.
 

CindyBS

  • Bristles
  • ***
  • Posts: 451
Re: In case ACA is overturned, then what?
« Reply #41 on: May 10, 2019, 04:35:51 PM »
If the ACA is thrown out, you will save money because you will no longer be forced to buy insurance that you don't use. If the ACA is replaced with government healthcare, then you still save money because your taxes will still be almost nil while living your mustachian lifestyle. There is no downside here.

Besides, isn't everyone maxing out their HSA?


Our family has had $2.5 Million of medical expenses in the last 3 years - all for a condition that was NOT pre-existing and we had no family history.  Before my son got sick our insurance was something we "didn't use" either.


We've maxed out our HSA for years - don't kid yourself on how absolutely catastrophically expensive an illness can be.  Very few people could have covered our medical expenses from an HSA and their entire net worth.

Also you completely neglect the protections of the ACA like prohibitions against lifetime maxes (which we would have hit), prohibitions on denying coverage based on pre-exisiting conditions, being able to stay on your parents' insurance until age 26 - all of which are the only things keeping my son insurable.  A huge downside for us if the ACA is overturned.


I am curious what condition results in $2.5 million in expenses, do you mind sharing?

No problem.  My teenage son got an aggressive form of leukemia (blood cancer).  He did 9 months of chemo which didn't work and then he had a bone marrow transplant.  Childhood cancer is much different than adult cancer in that they get pound for pound nearly twice the chemo dose as adults (because they are resilient enough to survive it.).   Consequently, chemo is typically not done in an outpatient setting like most adults, it is almost always done inpatient.  Also, there were many severe and life threatening infections he had to go to the hospital for.  He did 170 days in the hospital in 20 months, more than 50 in the ICU.  He also takes a maintenance chemo that cots $11,000 per month.

We had no indicated he was sick, no pre-existing condition that caused it, no family history of blood cancers, no family history of childhood cancer.  It literally came out of nowhere.   

The year before he got sick we had about $500 of medical expenses for our family of 4. 

Our previous, pre-ACA insurance policy had a lifetime max of $2Million per family member.  Without the protections of the ACA, he would have already maxed that out for life and he is still not an adult yet.  If it wasn't for this provision limiting a lifetime max, we would be a very difficult financial spot right now, if not on the verge of financial ruin.   

ETA - He is in remission and doing much better. 
« Last Edit: May 10, 2019, 04:37:55 PM by CindyBS »

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1192
Re: In case ACA is overturned, then what?
« Reply #42 on: May 11, 2019, 09:50:34 AM »
As a prudent investor, I wonder if this "ACA" law is inherently bad for the positive returns of the insurance industry.  The goal of any investor is to maximize returns.  Repeal of this law may bring in a substantial financial reward for many of us. The average price of a funeral is $7-8,000.  This is much less than the prices quoted above for the medical treatment of family members and puts a finality to the cash outflow from the given insurance company.

As the election of 2020 is not so far away, one must examine fiduciary concerns.  There may be a dual benefit in voting in the conservative direction.  Your tax dollars will be less than you will experience with their opposition and the example provided in the above paragraph indicates that the returns on your investments may be expected to be greater.

sol

  • Walrus Stache
  • *******
  • Posts: 8492
  • Age: 42
  • Location: Pacific Northwest
Re: In case ACA is overturned, then what?
« Reply #43 on: May 11, 2019, 10:59:54 AM »
As the election of 2020 is not so far away, one must examine fiduciary concerns.  There may be a dual benefit in voting in the conservative direction.  Your tax dollars will be less than you will experience with their opposition and the example provided in the above paragraph indicates that the returns on your investments may be expected to be greater.

I disagree with your assertion that taxes will be less under Trump than his opponent.  I think our tax laws were JUST changed, and are likely to generally stay put for the next 4-6 years.  We just don't change our tax laws that often.

I disagree with your assertion that repealing the ACA will be good for your personal investment returns.  The private health insurance industry is a parasite on the economy and generates essentially nothing of value, compared to what is provided by the governments of other comparable economies at lower cost with better outcomes.

I disagree with your unstated assertion that our new lower tax rates are good for the economy.  The current republican Congress put up record deficits by increase spending while decreasing revenues during a time of economic prosperity.  Trump, by asking for and supporting this disastrous plan, is arguably the LEAST financially responsible president in history, and the consequences of these policies will cost you money, in the long run.  Even Trump admits as much.

I disagree with your unstated assumption that repealing the ACA will benefit your overall financial pictures.  You are guaranteed to have health care costs, someday, and the threat to your personal financial well being from a medical bankruptcy far far FAR outweighs the threat to your personal financial well being from business-as-usual market returns from the healthcare sector.  Not to mention that threat to your literal well being.

And, finally, I disagree with the basic premise of your post, which is that you should vote for the party or the candidate that you believe (falsely, in this case) will confer the largest personal financial benefits.  Donald Trump has made a mockery of America and is a disgrace to our national values, such as diversity and inclusiveness.  He brags about sexual assaults.  He cheats on his wife with porn stars and then pays them hush money.  He works cooperatively with foreign governments to undermine our democracy.  He publicly threatens witnesses in the criminal investigations against him.  He has appointed more failed cabinet secretaries than any president in history because he values political obsequiousness more than competence.  He dodged military service by paying his family doctor to lie about bone spurs.  And oh, let's not forget, he's comically and disgustingly dishonest in everything he does and says and has been for his entire life.  He's a consummate con man, a business failure who projects a false image of success in order to swindle everyone around him.  America should rise up and publicly and overwhelmingly reject him as our standard bearer in 2020 because he has trampled our reputation, our Constitution, and our flag. 

FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #44 on: May 11, 2019, 11:39:46 AM »
As a prudent investor, I wonder if this "ACA" law is inherently bad for the positive returns of the insurance industry.  The goal of any investor is to maximize returns.  Repeal of this law may bring in a substantial financial reward for many of us. The average price of a funeral is $7-8,000.  This is much less than the prices quoted above for the medical treatment of family members and puts a finality to the cash outflow from the given insurance company.

As the election of 2020 is not so far away, one must examine fiduciary concerns.  There may be a dual benefit in voting in the conservative direction.  Your tax dollars will be less than you will experience with their opposition and the example provided in the above paragraph indicates that the returns on your investments may be expected to be greater.

While it's true that the economy and your investments are likely to do better under the Republican party as well as having lower tax rates, unless my investments really crash under the Democrats, I am better off with the ACA, if it's even still around in another year or two (a federal judge ruled it unconstitutional, and it's going through the appeals process now).  While the ACA will still leave me with higher premiums (my share) and much higher deductible and out of pocket costs than I current get through my job, I believe it would be far more costly for me in FIRE to go back to how things were before, plus I would lose some of the other protections provided by the ACA.  I might have to delay FIRE if the unconstitutionality ruling is upheld.

The economy and stock market have been going strong under Trump, and that's allowed many of us to build some healthy stashes, but if the economy it loses steam before the next election, he could be in trouble.  The democrats need to hope the economy goes to shit prior to that.
« Last Edit: May 11, 2019, 12:10:26 PM by FIREstache »

geekette

  • Handlebar Stache
  • *****
  • Posts: 1870
Re: In case ACA is overturned, then what?
« Reply #45 on: May 11, 2019, 11:42:21 AM »
As a prudent investor, I wonder if this "ACA" law is inherently bad for the positive returns of the insurance industry.  The goal of any investor is to maximize returns.  Repeal of this law may bring in a substantial financial reward for many of us. The average price of a funeral is $7-8,000.  This is much less than the prices quoted above for the medical treatment of family members and puts a finality to the cash outflow from the given insurance company.
So we should hope people just die because....money?

FIREstache

  • Pencil Stache
  • ****
  • Posts: 642
Re: In case ACA is overturned, then what?
« Reply #46 on: May 11, 2019, 12:06:19 PM »
By the way, based on past posts, pecunia is actually pro-ACA and for the democrats, so it appears pecunia is just being sarcastic or otherwise trolling for responses such as those above.

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1192
Re: In case ACA is overturned, then what?
« Reply #47 on: May 11, 2019, 03:46:34 PM »
By the way, based on past posts, pecunia is actually pro-ACA and for the democrats, so it appears pecunia is just being sarcastic or otherwise trolling for responses such as those above.

Right and Sol gave his best.  Except I'm not really pro ACA.  I think they should take steps to eliminate the insurance middlemen. 

BTDretire

  • Magnum Stache
  • ******
  • Posts: 2680
Re: In case ACA is overturned, then what?
« Reply #48 on: May 14, 2019, 09:34:26 AM »
 I'm still confused when people suggest it's good* to pay the insurance company the ACA subsidized rate,
$28,303, when my private plan is only $12,200. (and just as good)
See my previous post for details.

*Well, I guess it's good if you can get hardworking tax payers to pay for your health insurance.

Enigma

  • Bristles
  • ***
  • Posts: 482
  • Age: 40
  • Location: Clarksville, TN
Re: In case ACA is overturned, then what?
« Reply #49 on: May 14, 2019, 11:12:05 AM »
I was in better shape for retirement without the ACA.   There was a lot more companies with plans and more insurance companies fighting for my business.  I remember I could choose between BlueCross & Aetna and 12 others.  Instead after the chance BlueCross & Aetna was no longer offering their insurance in the county that I lived in.  Instead I had to choose one of the marketplace insurance companies in my area.

Also the premiums started doubling every year with less competition, more red tape, and massive corruption.  "Total cost of the HealthCare.gov website had reached $1.7 billion" according to wikipedia.  Anyway good riddens to the program and hoping for more variety and free market with healthcare.