FIREd: What are you going to do about healthcare if Obamacare gets overturned?

[Sandi_k]

I read somewhere that the average age of retirement is 62. This is not early from our perspective but many people are assuming they can work till 70 in order to maximise their SS checks.

Yes, this was a USA story from a couple of years ago, that stated the average age of retirement in the US was *61*. They noted three primary reasons:

1) You got laid off. Ageism is common, and is rampant in some industries - like tech.

2) You injure yourself and can no longer do the job: think nurse, landscaper, construction worker.

3) You leave the workforce to care for someone else who is ill, injured, or old. With no good safety net for our elders other than crazy-expensive nursing homes, it's frequently cheaper for a family member to take over day-to-day care.

I am planning for no later than 60.

[sherr]

The GOP has had every opportunity to repeal and replace ACA and they haven’t even bothered. That’s because they want they exact same thing as their corporatist brethren in the Democratic faction; single-payer socialized medicine.

That doesn't even make a lick of sense. Why would "corporatists" want single-payer socialized medicine? What we have now is far more expensive and far more corporation-friendly than anything else in the world.

[Paul der Krake]

The GOP has had every opportunity to repeal and replace ACA and they haven’t even bothered. That’s because they want they exact same thing as their corporatist brethren in the Democratic faction; single-payer socialized medicine.

That doesn't even make a lick of sense. Why would "corporatists" want single-payer socialized medicine? What we have now is far more expensive and far more corporation-friendly than anything else in the world.

Not really. Corporations who don't work in healthcare hate the status quo too. Yes there are some who rely on cheap labor and keep them under 30 hours a week, but the vast majority do provide insurance to their employees. It's a huge time sink for them, it's a huge time sink for employees who spend hours enrolling in plans, managing, and following up on their claims. Oh and their costs have kept going up year after year for decades. A single employee costs roughly 6k/year to cover, more if you are competing with premium labor that demands coverage for their families too. It's absolutely not a trivial cost, and absolutely not "corporation-friendly".

[sherr]

The GOP has had every opportunity to repeal and replace ACA and they haven’t even bothered. That’s because they want they exact same thing as their corporatist brethren in the Democratic faction; single-payer socialized medicine.

That doesn't even make a lick of sense. Why would "corporatists" want single-payer socialized medicine? What we have now is far more expensive and far more corporation-friendly than anything else in the world.

Not really. Corporations who don't work in healthcare hate the status quo too. Yes there are some who rely on cheap labor and keep them under 30 hours a week, but the vast majority do provide insurance to their employees. It's a huge time sink for them, it's a huge time sink for employees who spend hours enrolling in plans, managing, and following up on their claims. Oh and their costs have kept going up year after year for decades. A single employee costs roughly 6k/year to cover, more if you are competing with premium labor that demands coverage for their families too. It's absolutely not a trivial cost, and absolutely not "corporation-friendly".

Fair enough, I guess I was only thinking of insurance / health-care / pharmaceutical corporations, not "everyone else". I still think Buffalo is obviously wrong though. Republicans are very much doing everything they can to sabotage / destroy the ACA, which anyone can confirm for themselves with a couple minutes of googling. Both Democrats and Republicans agree on that fact. It takes quite the stretch of imagination to jump from "they haven't been able to come up with a replacement yet and just baaaarely haven't had enough votes to repeal it without one" to "they secretly want to keep it alive and move even further left".

[John Galt incarnate!]

Deleted.

[John Galt incarnate!]

My DH will have to keep working his well paid remote management job if he can’t retire early with reasonable health care via ACA, The only reason he is working is because there is a good chance ACA will not be there when we need it and we have pre-existing conditions

Another facet of this  to consider is that older less healthy employees Can’t retire and have to keep working because there is no where safe to get the insurance that will keep them from Medical bankruptcy.  They often farther along in their career and are keeping younger workers from getting promoted into higher paying jobs, and it prevents new young first line workers From getting their first serious good paying jobs that will allow them to buy houses and spend into the economy to build families.  Not allowing older folks to fire just to keep insurance prevents everyone below them from moving up.

The  persistence and ramifications of these economic inefficiencies are indeed frustrating.

"There's got to be a better way."

[jim555]

Please don't listen to this poster on ACA, they don't know what they're talking about.

They didn't do "nothing".

-Ditched the individual mandate , which is critical for the health of the insurance pool
-Cut the open enrollment period in half
-Reduced outreach/advertising for federally run marketplaces, causing states defaulting to the federal market place to lag behind states running their own markets in terms of enrollment

Just adding a few more...
-Cut the funding for the Silver plan cost sharing reductions
-Killed the Risk Corridor payments
-Allow states to add work requirements to Medicaid via a 1115 waiver request.  These have been struck down in the courts, but more cases are pending.

[HPstache]

I'm not FIRE'd, and I currently get health insurance through work.  But if not, the answer would be a Health share ministry.  Maybe the MMM forum could start their own health share ministry following the teachings of Guru Pete.

[OtherJen]

I'm not FIRE'd, and I currently get health insurance through work.  But if not, the answer would be a Health share ministry.  Maybe the MMM forum could start their own health share ministry following the teachings of Guru Pete.

Read the fine print carefully: https://www.google.com/amp/s/www.nytimes.com/2020/01/02/health/christian-health-care-insurance.amp.html

[HPstache]

I'm not FIRE'd, and I currently get health insurance through work.  But if not, the answer would be a Health share ministry.  Maybe the MMM forum could start their own health share ministry following the teachings of Guru Pete.

Read the fine print carefully: https://www.google.com/amp/s/www.nytimes.com/2020/01/02/health/christian-health-care-insurance.amp.html

I'm behind the paywall... what's the TLDR?  I am sure that the max benefit of these programs at around $1M is one of the criticized points?  Possibly that not all conditions are covered or that are subject to the opinion of the health share?  Maybe that heavy drinking, smoking or sexual relations outside of marriage are often prohibited?  These are all valid points, but I don't think they would prevent me from using a healthshare in my FIRE years if the ACA is not available.

[sherr]

I'm not FIRE'd, and I currently get health insurance through work.  But if not, the answer would be a Health share ministry.  Maybe the MMM forum could start their own health share ministry following the teachings of Guru Pete.

Read the fine print carefully: https://www.google.com/amp/s/www.nytimes.com/2020/01/02/health/christian-health-care-insurance.amp.html

I'm behind the paywall... what's the TLDR?  I am sure that the max benefit of these programs at around $1M is one of the criticized points?  Possibly that not all conditions are covered or that are subject to the opinion of the health share?  Maybe that heavy drinking, smoking or sexual relations outside of marriage are often prohibited?  These are all valid points, but I don't think they would prevent me from using a healthshare in my FIRE years if the ACA is not available.

You can read most anything by opening the link in a "private browsing window". The only one that doesn't work on is Washington Post I think.

Health share ministries are not insurance, and there is no guarantees of coverage at all, so they're under no obligation to pay claims. My parents are on one and they've had them pay out as expected when they had medical issues, but you're depending on the trustworthiness of the administrators. They could just decide to drop you.

[FireLane]

I'm behind the paywall... what's the TLDR?  I am sure that the max benefit of these programs at around $1M is one of the criticized points?  Possibly that not all conditions are covered or that are subject to the opinion of the health share?  Maybe that heavy drinking, smoking or sexual relations outside of marriage are often prohibited?  These are all valid points, but I don't think they would prevent me from using a healthshare in my FIRE years if the ACA is not available.

The TLDR is that health share ministries are what insurance used to be before Obamacare: they can deny you for pre-existing conditions or cancel your coverage if you come down with an expensive illness.

[HPstache]

I'm not FIRE'd, and I currently get health insurance through work.  But if not, the answer would be a Health share ministry.  Maybe the MMM forum could start their own health share ministry following the teachings of Guru Pete.

Read the fine print carefully: https://www.google.com/amp/s/www.nytimes.com/2020/01/02/health/christian-health-care-insurance.amp.html

I'm behind the paywall... what's the TLDR?  I am sure that the max benefit of these programs at around $1M is one of the criticized points?  Possibly that not all conditions are covered or that are subject to the opinion of the health share?  Maybe that heavy drinking, smoking or sexual relations outside of marriage are often prohibited?  These are all valid points, but I don't think they would prevent me from using a healthshare in my FIRE years if the ACA is not available.

You can read most anything by opening the link in a "private browsing window". The only one that doesn't work on is Washington Post I think.

Health share ministries are not insurance, and there is no guarantees of coverage at all, so they're under no obligation to pay claims. My parents are on one and they've had them pay out as expected when they had medical issues, but you're depending on the trustworthiness of the administrators. They could just decide to drop you.

I'm behind the paywall... what's the TLDR?  I am sure that the max benefit of these programs at around $1M is one of the criticized points?  Possibly that not all conditions are covered or that are subject to the opinion of the health share?  Maybe that heavy drinking, smoking or sexual relations outside of marriage are often prohibited?  These are all valid points, but I don't think they would prevent me from using a healthshare in my FIRE years if the ACA is not available.

The TLDR is that health share ministries are what insurance used to be before Obamacare: they can deny you for pre-existing conditions or cancel your coverage if you come down with an expensive illness.

Yes, that did work, thanks for that tip.  And yes, that is true that they are NOT insurance and there are no guarantees.  However, the track record of the top health shares is that the behave like insurance to the point where I would feel comfortable with using one in my FIRE years.  In these years I plan on having all of my children out of the house and on their own, and that makes a big difference in my eyes if it is just my wife and I participating in the health share.  Although they are under no obligation to pay claims... the track records I have found say they do pay claims, hearing the same positive feedback as it sounds you are hearing from your family who also participate. 

I will argue that they cannot just decide to drop you, at least not if you are operating within the rules you agreed to when you signed up.  All the Health Share Websites I have been to in my past research say they cannot drop you if you have an expensive illness, this is a requirement of the law:

"(III) members of which retain membership even after they develop a medical condition"

I understand that it is not the best option for everyone, but I do believe that if there is no ACA or Single Payer health care by the time I am 50, I would absolutely get in a Health Share, even knowing the cons of being in one.

[Viking Thor]

The reason health sharing are so cheap is they don't cover many situations that could bankrupt you.

Most don't cover prescription drugs or only do so to a very minimal level.

That alone is an enormous gap/ risk.

There are many medications that cost exorbitant amounts, like $100k+ per year. And you are ok / healthy with the medication but need it.

The sharing plans don't cover this and other high ticket items, they are essentially covering medium and lower costs.

High cost conditions can cost million+ over time.

[BTDretire]

Also at the federal level, there could be some additional actions especially if the democrats win the senate and WH.

This is one of many, many reasons that I am working hard to make sure Democrats win. If anyone else wants to preserve their healthcare, let me know. I can direct you to the best ways to help.

I still haven't figured out why someone makng $60k a year should have to subsidize the health insurance of someone that has so much money they never have to have work for money again.
 Looks like our votes will be a wash.

[nereo]

Also at the federal level, there could be some additional actions especially if the democrats win the senate and WH.

This is one of many, many reasons that I am working hard to make sure Democrats win. If anyone else wants to preserve their healthcare, let me know. I can direct you to the best ways to help.

I still haven't figured out why someone makng $60k a year should have to subsidize the health insurance of someone that has so much money they never have to have work for money again.

It all comes down to how you view health care: whether you view it as a fundamental right of every citizen living in a developed country which ultimately benefits society in general, or as an individual's responsibility where the level of care and coverage is based on what the particular individual is willing and able to pay for in advance.

It may help you to think about education as a parallel example. Do we collectively provide access to education for everyone, and if so to what age, level and degree? As a society we've gone from offering only public elementary school in some areas to requiring high-school everywhere until adulthood.  Most now agree that offering a HS-level education at little to no cost is something which definitely benefits society at large.  Lately there are serious discussions about the cost and necessity of higher education.  At the same time, some (mostly wealthy) families wish to send their children to private schools, and often expect vouchers or tax-breaks for doing so.

Health-care is similar in many ways.  It doesn't have to be "all-or-none", but there is less consensus about how much health care should be available at no-cost to the patient, and where and how to draw lines about what should be available and to whom. These discussions persist even in areas with single-payer health care, though the discussions are less about routine care and more about issues like nursing home quality and experimental or QoL treatments.

[seattlecyclone]

I don't even care so much about the subsidy aspect during FIRE. Low-income millionaires such as myself are quite rare. Subsidies for those of us in that category are minuscule compared to subsidies for low-income non-millionaires, but if that's your biggest hang-up with the law it's not that big of a deal for me if they rewrote it to exclude high-net-worth individuals from the subsidies. I can afford the sticker price of a marketplace plan with little to no lifestyle change required. The bigger deal is if we go back to the pre-ACA status quo there's a reasonable possibility that I wouldn't be able to purchase insurance for my family at any price without going back to a corporate job.

[Exflyboy]

I don't even care so much about the subsidy aspect during FIRE. Low-income millionaires such as myself are quite rare. Subsidies for those of us in that category are minuscule compared to subsidies for low-income non-millionaires, but if that's your biggest hang-up with the law it's not that big of a deal for me if they rewrote it to exclude high-net-worth individuals from the subsidies. I can afford the sticker price of a marketplace plan with little to no lifestyle change required. The bigger deal is if we go back to the pre-ACA status quo there's a reasonable possibility that I wouldn't be able to purchase insurance for my family at any price without going back to a corporate job.

Absolutely! Sure I don't WANT to pay $1500/month for shyte insurance but I certainly could with zero lifestyle impact. I am much more concerned about the other ACA provisions ans honestly I want low income/low NW worth people to get affordable care.

[RetiredAt63]

Also at the federal level, there could be some additional actions especially if the democrats win the senate and WH.

This is one of many, many reasons that I am working hard to make sure Democrats win. If anyone else wants to preserve their healthcare, let me know. I can direct you to the best ways to help.

I still haven't figured out why someone makng $60k a year should have to subsidize the health insurance of someone that has so much money they never have to have work for money again.
 Looks like our votes will be a wash.

As @nereo points out it's for the same reason someone with no kids who makes $30k/year and owns a house pays taxes to subsidize the person who has 5 kids in public school and makes $500k/year. We feel its best for our society and citizens to provide that.

This has been discussed elsewhere on the forums, but basically it is an investment in social well-being and in the long run costs less.  People go to a doctor or walk-in clinic before they get really sick.*  We still have suplementaty insurance but the basics are covered.   

*I've seen discussions elsewhere that Americans are open to home remedies much more than in other places because they are so reluctant to go to the doctor because of cost.

Canadians love their (not free, paid for by taxes) universal health care so much that no party would suggest ditching it.  Conservative provincial governments float 2-tier systems that generally sink.

[Exflyboy]

Same thig with the National Health Service (NHS) in the UK. Thats the closest thing you will get to a national religion in the UK.. Namely any politician that suggests privatising it will get burned at the stake!

This has not stopped the UK Conservative (Republican) Government from defunding it and then screaming about how much more efficient it would be if it was a for profit system... Namely, they and their buddies make more money from the system, sound familiar?

[billy]

Planet money just had a good podcast about health care in the US and throughout the decades how health care industry try to block privatization, very interesting.

[nereo]

Planet money just had a good podcast about health care in the US and throughout the decades how health care industry try to block privatization, very interesting.

Is this the one that you mean?  Couldn't find a more recent episode (this was a short segment broadcast on March 2020)
https://www.npr.org/2020/03/12/815128921/healthcare-and-economic-despair

[billy]

That's The Indicator, check out Planet Money "Frame Canada." This is probably their best podcast all year (maybe because I want to visit Canada and have someone bump into me and say, "Sorrry.") It's fitting with all the ACA novelas going on.
https://www.npr.org/podcasts/510289/planet-money

[Wintergreen78]

Same thig with the National Health Service (NHS) in the UK. Thats the closest thing you will get to a national religion in the UK.. Namely any politician that suggests privatising it will get burned at the stake!

This has not stopped the UK Conservative (Republican) Government from defunding it and then screaming about how much more efficient it would be if it was a for profit system... Namely, they and their buddies make more money from the system, sound familiar?

The VA here is probably the closest to what a national healthcare system would loom like in the US if ever adopted. People trash talk it but I and most Vets who use it really like it and would hate for it to be privatized as most Republicans have wanted to do. Trump tried but had so much opposition that he conceded and it remains the closest thing to socialized healthcare I've seen in the US. They now combine it with access to private healthcare to so a bit more functional now.

My grandad got his health care through the VA and my uncle still does. Both of them were happy with it.

[iris lily]

Catastrophic plans are currently only available for those under 30. There's a hardship exemption but it has specific rules, like being homeless.

World travel is my last ditch plan but, hopefully, moving to a state with a plan is feasible.

I really don't want to work at a corporate or government job until I'm eligible for medicare (65?).

It was the ACA that removed catastrophic plans from us as an option.

Of course, “catastrophic” costs are the devil in the details, but I would have been fine with a $50,000 and possible higher deductible annually untl I hit
Medicare age. But t hat was only about  5 years for me. You younguns have a different sitch.

[dresden]

Also at the federal level, there could be some additional actions especially if the democrats win the senate and WH.

This is one of many, many reasons that I am working hard to make sure Democrats win. If anyone else wants to preserve their healthcare, let me know. I can direct you to the best ways to help.

I still haven't figured out why someone makng $60k a year should have to subsidize the health insurance of someone that has so much money they never have to have work for money again.
 Looks like our votes will be a wash.

According to the facts ACA makes up 5% of the subsidies for folks under 65 and employee plans make up 35% of the federal subsidies: https://www.cbo.gov/publication/56571

Early retirees make up a tiny tiny percent of that 5% I am sure.  It makes no sense to focus on that.

Most of the people on these forums worked for a living and paid high taxes during their working year - much higher rates than the super wealthy that continue to get a bigger share of the pie as time marches on.

There are many tax benefits for the wealthy - most early retirees are frugal people that saved - not wealthy.

I don't even care so much about the subsidy aspect during FIRE. Low-income millionaires such as myself are quite rare. Subsidies for those of us in that category are minuscule compared to subsidies for low-income non-millionaires, but if that's your biggest hang-up with the law it's not that big of a deal for me if they rewrote it to exclude high-net-worth individuals from the subsidies. I can afford the sticker price of a marketplace plan with little to no lifestyle change required. The bigger deal is if we go back to the pre-ACA status quo there's a reasonable possibility that I wouldn't be able to purchase insurance for my family at any price without going back to a corporate job.

Assets can easily be converted to an income stream that can be used to determine eligibility.  The same can be done with taxes and the wealthy benefit from that much more than early retirees.

What # would be used - probably like 2% so that is 20,000 of imputed income per million. An asset test really only makes sense if the assets are computed into an income stream and added to other income sources. 

I retired early primarily because of serious car accident injuries.  Do they really want to force me on social security disability so I can get insurance vs working seasonal part time and buying ACA?  It really doesn't make any sense to focus on the subsidies which are tiny and offset by other taxes anyhow.

[bmjohnson35]

I haven't seen much responses to the OP's original question:

Spouse is unwilling to move abroad and pre-existing conditions prevent me from obtaining insurance privately.  If the ACA is fully dismantled, I will probably seek out a part-time job where they offer adequate coverage and wait to see what becomes available with future policy.

 

[CCCA]

We are currently on ACA and getting modest subsidies.  We also live in urban California and it seems likely that even without the ACA we can get affordable health insurance plans.


I do wonder if the Dems take over the Senate and Presidency, that they can craft a replacement plan that will survive a conservative supreme court.

[sherr]

I do wonder if the Dems take over the Senate and Presidency, that they can craft a replacement plan that will survive a conservative supreme court.

Unnecessary, if the Dems retake the Senate they can just set the Individual Mandate penalty back to $1 or higher and the entire basis for the supreme court case goes away before the SC would rule on the case anyway. The problem is if they don't retake the Senate. Does anyone here believe that the Senate Republicans would be willing to work towards a compromise health bill with the House Democrats?

I would also like to see them expand the ACA by adding a public option to Medicaid, but that's not particularly relevant either.

[CCCA]

I do wonder if the Dems take over the Senate and Presidency, that they can craft a replacement plan that will survive a conservative supreme court.

Unnecessary, if the Dems retake the Senate they can just set the Individual Mandate penalty back to $1 or higher and the entire basis for the supreme court case goes away before the SC would rule on the case anyway. The problem is if they don't retake the Senate. Does anyone here believe that the Senate Republicans would be willing to work towards a compromise health bill with the House Democrats?

I would also like to see them expand the ACA by adding a public option to Medicaid, but that's not particularly relevant either.

Thanks, hopefully that is the case (both the ease of changing the current ACA and expanding to a public option).

[rab-bit]

PTF

[HPstache]

Interested MMM blog post today regarding Health Shares:

https://www.mrmoneymustache.com/2020/11/09/direct-primary-care/

[Wintergreen78]

Not buying insurance and paying your doctor directly is a great way to save money as long as you never have to go to the hospital. You could save $10,000 a year for a decade. Of course, one week in the ICU will completely wipe out those savings if you ever have something bad happen.

It is an interesting thought exercise though, how much extra cash would you need to be comfortable dropping insurance? If I had an extra $2,000,000 over what I needed to support my regular expenses, I think I’d be comfortable dropping insurance. I don’t know that an extra $1,000,000 would be enough for my peace of mind though. What is your risk tolerance?

[bacchi]

It is an interesting thought exercise though, how much extra cash would you need to be comfortable dropping insurance? If I had an extra $2,000,000 over what I needed to support my regular expenses, I think I’d be comfortable dropping insurance. I don’t know that an extra $1,000,000 would be enough for my peace of mind though. What is your risk tolerance?

Agreed. Given that $1M was often the lifetime maximum per plan, pre-ACA, one would need at least that much.

That extra amount would also need to keep up with health care inflation even in a down market, of course.

[CCCA]

It's speculative for sure, but here's an analysis of oral arguments at the Supreme Court:
https://reason.com/volokh/2020/11/10/thoughts-on-todays-oral-argument-in-california-v-texas-the-obamacare-severability-case/


Basically, the author thinks, based on questioning, that the severability issue won't cause the entire law to be overturned.  And @sherr had the comment that changing the penalty to be non-zero could also fix the issue.

[sherr]

Frankly I don't understand why there's even a reasonable chance that the Individual Mandate gets struck down at all, even if we presuppose that the argument that a $0 Mandate is unconstitutional is correct.

If something was constitutional before,
and then Law X changes something,
and then it's not constitutional after,
then Law X's changes were the unconstitutional part, not something that preexisted them.

If they do anything the Supreme Court should strike down the TCJA change of setting the Mandate Penalty to $0.

[BuildingFrugalHabits]

Yeah, this was my thought as well.  I don't understand the logic of suing to try to repeal the ACA under these circumstances when it was the TCJA that was responsible for altering the penalty for failing to get health insurance. 

[Wintergreen78]

It’s almost like some group was trying to get rid of Obamacare for ideological reasons, but they knew it would be massively unpopular to make people lose health care, so they tried to engineer some convoluted process that would allow them to deny responsibility.