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.
- 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.
“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?
“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?
- 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/
- 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!
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.
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 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?
If the ACA is struck down, many Mustachians may go back to work.
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.
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.
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.
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.
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.
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.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?
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 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 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?
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.
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.
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?
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.
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.
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?
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. 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.
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
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?
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.
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.
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?
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.
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)
Well, I guess it's good if you can get hardworking tax payers to pay for your health insurance.
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.
Anyway good riddens to the program and hoping for more variety and free market with healthcare.
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.
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.
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.
It's super frustrating every time I hear someone say the individual mandate has been removed because that is technically incorrect. This just tells you that the current administration has done a great job of spinning it that way. The penalty for not having health insurance is still there, they just lowered it to $0. If I changed the penalty for a felony conviction to no consequence, you're still a felon. It's pure gamesmanship.
It's super frustrating every time I hear someone say the individual mandate has been removed because that is technically incorrect. This just tells you that the current administration has done a great job of spinning it that way. The penalty for not having health insurance is still there, they just lowered it to $0. If I changed the penalty for a felony conviction to no consequence, you're still a felon. It's pure gamesmanship.
We're rich, so we'll be fine, but the healthcare situation in the US is a disaster and believing that magic will happen and everyone will be taken care of is just dreaming. If presented the option to write a check for $500k to have 100% coverage for the rest of our lives, I'd likely do it.Read my post more carefully, I never said everyone will be fine. I said "money buys options", including moving to another country.
But the mandate is still the law, just gaming the system to $0 doesn't change that. The next budget bill could change it back to >$0.It's super frustrating every time I hear someone say the individual mandate has been removed because that is technically incorrect. This just tells you that the current administration has done a great job of spinning it that way. The penalty for not having health insurance is still there, they just lowered it to $0. If I changed the penalty for a felony conviction to no consequence, you're still a felon. It's pure gamesmanship.
Being a felon still has negative consequences external to jail time, whereas breaking the "mandate" has none. Is a mandate with no penalty really a mandate? Seems more like a suggestion at that point.
We're rich, so we'll be fine, but the healthcare situation in the US is a disaster and believing that magic will happen and everyone will be taken care of is just dreaming. If presented the option to write a check for $500k to have 100% coverage for the rest of our lives, I'd likely do it.Read my post more carefully, I never said everyone will be fine. I said "money buys options", including moving to another country.
I think we're completely in agreement here. You and I and virtually everyone reading this will be fine. Others, maybe, maybe not.