Author Topic: What comes after the ACA?  (Read 385531 times)

sol

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Re: What comes after the ACA?
« Reply #1300 on: March 07, 2017, 08:40:32 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

boarder42

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Re: What comes after the ACA?
« Reply #1301 on: March 07, 2017, 08:55:52 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.
.

in any other form of insurance you pay based on your risk profile.  older people are riskier and cost more i like the fact that they can be charged up to 5x more.  you can tell much of this plan was made with insurance companies in mind.  If its going to stay private i want the choice to control my costs.  this plan allows for me to do just that.  and guess what.  if the aca had stayed in place we would start to see larger migration to healthshare and insurers may have all left the market place.  if you plan to retire right around the top of the 15% bracket then this plan helps you loads more than the previous one.  i see no way we can affordably insure all people and have insurance companies make profit.  So i guess i just dont care about leaving people under insured b/c if we dont have a central payer then we have determined health coverage is a privledge not a right.  you have to fundamentally change that to make this "affordable"
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panda

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Re: What comes after the ACA?
« Reply #1302 on: March 07, 2017, 08:57:56 AM »
3.  Insurance companies can't deny you if you have a pre-existing condition (though they can charge you more).
This right here means that the entire thing is DOA. There is no way that the health insurance industry is going to allow people with expensive pre-existing conditions to enroll for anything near reasonable premiums. It just doesn't make economic sense. This is effectively a return to the system prior to the ACA except that the insurance companies can now gouge people for an additional 30% if their coverage lapses for some reason.

I'm not sure the GOP understands how health insurance works.
Of course the problem is that it's not really insurance per se - that might be a topic for another thread though.

brooklynguy

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Re: What comes after the ACA?
« Reply #1303 on: March 07, 2017, 09:06:55 AM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
Where do you get refundable?
From the link linked:
https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

ctrl+f "refundable"

The word "refundable" does not appear in the PDF it cites as a source. But "credit" only appears twice and not in meaningful sentences. If someone has the time to parse the 66 pages of legalese, have at it. :)

The PDF of the full-text bill linked to in the Consumerist article is not the bill that contains the provisions for the refundable tax credit.  Those provisions are in a separate bill (here's a link to a PDF copy:  Ways and Means Committee Legislative Recommendations) -- the tax credit language is contained in Section 15 of the bill (starting on page 23 of the PDF file), which adds a new refundable tax credit to subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code (which is the area of the tax code where refundable tax credits for personal income taxes are generally located).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The difference is that under this plan no penalty would apply to individuals who opt never to purchase health insurance at all.  In practice, for anyone who ends up purchasing health insurance after a lapse in coverage, the effect is as you described.  But the proposed structure will allow the GOP to credibly claim that people are no longer forced, under pain of penalty, to purchase coverage they don't want, because you can choose to purchase no insurance at all and face no penalty.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1304 on: March 07, 2017, 09:08:28 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them.  The government has been fucking over the middle class for way too long.

Gin1984

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Re: What comes after the ACA?
« Reply #1305 on: March 07, 2017, 09:12:14 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them.  The government has been fucking over the middle class for way too long.
Exactly how did the ACA harm the middle class, given the median income is $51000 for a family and that is well within the subsidy range?

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Wexler

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Re: What comes after the ACA?
« Reply #1306 on: March 07, 2017, 09:13:20 AM »
Adrian, you should look into the concept of diffuse costs and concentrated benefits. If everything worked based on who comes out mathematically ahead, taxes on the rich would be much higher since the vast majority of Americans are not rich.
I think you misunderstood my point. The Republicans said they'd repeal Obamacare, which we all know means millions of poor people will lose their health insurance. Many millions of people voted for this. They want this, because they don't want to have to pay for it.

People who are not rich voted in the millions for a party that promises to cut taxes on the rich. They won't vote against this party at the next election, when the party is just doing what they said they'd do. There's no bait and switch.
Trump ran on replacing ACA with something better, lower costs/premiums/deductibles - with everyone covered.  When his red capped voters find out how much they are screwed by this they will not be voting R again for a while.  I am assuming they are smart enough not to blame Obama for the changes.
Hard to say. They might like the tax refund and the lack of mandate to buy healthcare with it. The medicare issues could be blamed on the states for not ponying up the money, and Trump comes out looking like a winner.

Maybe not, but the spin machine has been in high gear for awhile.

Can the refundable tax credits go to households that don't use them for health insurance? That doesn't seem like it should work that way.  If so, it would just be a new tax credit based on age and with an income-based phaseout.  Full stop.  If you have to buy health insurance to get a tax credit, isn't that a "mandate to buy healthcare with it"?  There would be no mandate to buy healthcare in general, but to get the credit, you'd have a mandate to use it.

Wexler

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Re: What comes after the ACA?
« Reply #1307 on: March 07, 2017, 09:18:39 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them.  The government has been fucking over the middle class for way too long.

But then why do they keep voting for the "whatever else, keep cutting taxes on the rich" school of government?  I mean, the Medicare surcharge tax of 0.9% on earned income over 250k  AND (this is a huge boon to the investment class) on investment income over 250k is eliminated as part of this bill.  How does this help the middle class?  This isn't choosing something different, it's just choosing a tackier facade papered over Mitt Romney's economic policies. 

brooklynguy

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Re: What comes after the ACA?
« Reply #1308 on: March 07, 2017, 09:24:07 AM »
Can the refundable tax credits go to households that don't use them for health insurance?

No.  The refundable tax credits are capped at the lesser of the amount otherwise specified and the amount actually paid for eligible health insurance (see the new Section 36(C)(b)(1) to be added to the tax code pursuant to the bill, starting on page 24 of the PDF file).

EnjoyIt

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Re: What comes after the ACA?
« Reply #1309 on: March 07, 2017, 09:30:41 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them.  The government has been fucking over the middle class for way too long.
Exactly how did the ACA harm the middle class, given the median income is $51000 for a family and that is well within the subsidy range?

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Just because you get a small subsidy does not mean you are better off.  Especially if you lost your decent insurance from work and then must pay out of pocket for a crappier policy with a $6000 deductible and you still must cover 20%.  Middle class got fucked hard with the ACA. 

EnjoyIt

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Re: What comes after the ACA?
« Reply #1310 on: March 07, 2017, 09:33:57 AM »

But then why do they keep voting for the "whatever else, keep cutting taxes on the rich" school of government?  I mean, the Medicare surcharge tax of 0.9% on earned income over 250k  AND (this is a huge boon to the investment class) on investment income over 250k is eliminated as part of this bill.  How does this help the middle class?  This isn't choosing something different, it's just choosing a tackier facade papered over Mitt Romney's economic policies.

I don't know who "they" are that you are referring to.  I do agree that the Republican plan is no better than ACA.  Luckily I may get a tax cut and maybe be able to purchase a less expensive insurance product that fits my needs better.  None if it will fix the cost of healthcare.

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Re: What comes after the ACA?
« Reply #1311 on: March 07, 2017, 09:40:02 AM »
Can the refundable tax credits go to households that don't use them for health insurance?

No.  The refundable tax credits are capped at the lesser of the amount otherwise specified and the amount actually paid for eligible health insurance (see the new Section 36(C)(b)(1) to be added to the tax code pursuant to the bill, starting on page 24 of the PDF file).
Thank you for this info.
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JLee

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Re: What comes after the ACA?
« Reply #1312 on: March 07, 2017, 09:41:25 AM »
A majority of online and social media defenders of Obamacare are professionals who are “paid to post,” according to a digital expert.

“Sixty percent of all the posts were made from 100 profiles, posting between the hours of 9 and 5 Pacific Time,” said Michael Brown. “They were paid to post.”
 

It wouldn't surprise me if 60% of the posts on this forum come from the top 100 posters.  Of course, some of those top 100 absolutely hate the ACA.

It also wouldn't surprise me if (a different) 60% of posts were made between 9am and 5pm.

But I'm especially enamored of this quote, because it manages to tie together active denial of the fact that Americans are protesting the GOP repeal of the the ACA, a conspiracy theory about paid protestors, and a dig at left coasters.  All in one succinct little pile of crazy.

I 100% agree most of them were paid to post.  By their employers, but for the job they were supposed to be doing instead of screwing around on the internet.

My employer doesn't care as long as my shit is working.

My shit is working.

:)

thenextguy

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Re: What comes after the ACA?
« Reply #1313 on: March 07, 2017, 09:41:37 AM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
Where do you get refundable?
From the link linked:
https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

ctrl+f "refundable"

The word "refundable" does not appear in the PDF it cites as a source. But "credit" only appears twice and not in meaningful sentences. If someone has the time to parse the 66 pages of legalese, have at it. :)

The PDF of the full-text bill linked to in the Consumerist article is not the bill that contains the provisions for the refundable tax credit.  Those provisions are in a separate bill (here's a link to a PDF copy:  Ways and Means Committee Legislative Recommendations) -- the tax credit language is contained in Section 15 of the bill (starting on page 23 of the PDF file), which adds a new refundable tax credit to subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code (which is the area of the tax code where refundable tax credits for personal income taxes are generally located).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The difference is that under this plan no penalty would apply to individuals who opt never to purchase health insurance at all.  In practice, for anyone who ends up purchasing health insurance after a lapse in coverage, the effect is as you described.  But the proposed structure will allow the GOP to credibly claim that people are no longer forced, under pain of penalty, to purchase coverage they don't want, because you can choose to purchase no insurance at all and face no penalty.

Right, if you don't have insurance you're incentivized to wait as long as possible to get insurance because whether you get it tomorrow or 10 years from now, the penalty will be the same. Under the individual mandate, you're penalized every year you don't get insurance.

sol

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Re: What comes after the ACA?
« Reply #1314 on: March 07, 2017, 09:42:54 AM »
in any other form of insurance you pay based on your risk profile.  older people are riskier and cost more i like the fact that they

Really?  Because it seems to me that my employer sponsored health insurance works really well, and it charges the same flat rate to every enrollee regardless of their risk profile.  That's what makes group insurance work.

If you're going to charge more to people who use more, why not just go all the way and charge everyone their actual costs?  That's not really insurance at all, is it?  Is that the model were moving towards here?

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Re: What comes after the ACA?
« Reply #1315 on: March 07, 2017, 09:48:43 AM »
Trump ran on replacing ACA with something better, lower costs/premiums/deductibles - with everyone covered.  When his red capped voters find out how much they are screwed by this they will not be voting R again for a while.  I am assuming they are smart enough not to blame Obama for the changes.
Trump is behind the new bill. He tweets:

"Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster - is imploding fast!"

Like the rest of the population, most of Trump's supporters don't buy health insurance on the individual market. They believe this doesn't negatively impact them.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1316 on: March 07, 2017, 09:56:14 AM »

Like the rest of the population, most of Trump's supporters don't buy health insurance on the individual market. They believe this doesn't negatively impact them.

Are you sure?  The 1% is a very small population. Almost half the country voted for trump. A large portion of which are middle class.  These are the people that got fucked over the most with the ACA.  Even employer sponsored plans had to comply with ACA regulations.  Most employees pay more and get less benefits with higher deductibles.  These people are pissed off and want reform.  Unfortunately the republican plan does nothing about cost.  It is just shifting the burden on who pays for it.  It will also fail.

AdrianC

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Re: What comes after the ACA?
« Reply #1317 on: March 07, 2017, 09:58:20 AM »
This new plan is worse for virtually everyone, and that's be design. 

If I keep our income down my family will go from zero subsidy to a tax credit of $12,500. That's a pretty nice benefit for the upper middle class.

The Republicans have been complaining for years that Obamacare premiums and deductibles are too high. I expect this new plan will cause my own premiums and deductibles for the same policy to be higher, not lower. The tax credit will come in handy, though. Net we will probably be better off.

If we are able to buy a high deductible catastrophic plan and sock $13K or so a year in an HSA I expect we will be quite a bit better off, assuming continued good health.

jim555

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Re: What comes after the ACA?
« Reply #1318 on: March 07, 2017, 09:59:28 AM »
Trump supporters may not be directly impacted, but family members and relatives who got the short end do talk.

AdrianC

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Re: What comes after the ACA?
« Reply #1319 on: March 07, 2017, 10:03:14 AM »

Like the rest of the population, most of Trump's supporters don't buy health insurance on the individual market. They believe this doesn't negatively impact them.

Are you sure?  The 1% is a very small population. Almost half the country voted for trump. A large portion of which are middle class.  These are the people that got fucked over the most with the ACA.  Even employer sponsored plans had to comply with ACA regulations.  Most employees pay more and get less benefits with higher deductibles.  These people are pissed off and want reform.  Unfortunately the republican plan does nothing about cost.  It is just shifting the burden on who pays for it.  It will also fail.

Trump's supporters on the whole will not see this new plan as a negative. It "repeals Obamacare". That's a positive, for most of them.

sol

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Re: What comes after the ACA?
« Reply #1320 on: March 07, 2017, 10:06:57 AM »
Almost half the country voted for trump.

Technically, it was more like one fifth of the country that voted for trump.

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Re: What comes after the ACA?
« Reply #1321 on: March 07, 2017, 10:11:25 AM »

Like the rest of the population, most of Trump's supporters don't buy health insurance on the individual market. They believe this doesn't negatively impact them.

Are you sure?  The 1% is a very small population. Almost half the country voted for trump. A large portion of which are middle class.  These are the people that got fucked over the most with the ACA.  Even employer sponsored plans had to comply with ACA regulations.  Most employees pay more and get less benefits with higher deductibles.  These people are pissed off and want reform.  Unfortunately the republican plan does nothing about cost.  It is just shifting the burden on who pays for it.  It will also fail.

Most surveys show that the ACA was a concern of Trump voters, but not their primary concern (spoiler alert: it was brown people).  Many Trump voters thought he'd leave the ACA alone or just magically lower the costs for rural white people. 

I agree with you that cost is a major problem that is minimally addressed by the ACA and I'm not sure what this bill does to contain costs.

ACA cost-bending provisions:

1. Cap on insurance profits (20% for group plans, 15% for individual plans)
2. Bundled medicare payments (fixed payments for readmissions after surgery)
3. Shifting many insured onto Medicare, which has lower payments relative to private insurance

I can't imagine that #1 survives repeal, not sure about #2, and #3 is being phased out per the bill.  A large portion of our GDP is spent healthcare, and that means that it provides a lot of jobs.  It also provides a lot of Aspen homes for insurance company execs, boats and Disney vacations for pharma reps, and third wives for plastic surgeons. Of the various inefficiencies in healthcare, I suspect that docs will take it on the chin before any execs do.  The AMA is a good lobby, but it can't hold a candle to what corporations can pay for. 


Paul der Krake

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Re: What comes after the ACA?
« Reply #1322 on: March 07, 2017, 10:42:22 AM »
So if your income is under the 75/150k cutoff, you get the entire credit right?

Doesn't matter if I make only $20,000/year, so long as I buy insurance for $2,500 I will get the whole $2,500?

Gin1984

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Re: What comes after the ACA?
« Reply #1323 on: March 07, 2017, 10:50:18 AM »
So if your income is under the 75/150k cutoff, you get the entire credit right?

Doesn't matter if I make only $20,000/year, so long as I buy insurance for $2,500 I will get the whole $2,500?
It is funny that you think you can get health insurance for $2500/year.

thenextguy

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Re: What comes after the ACA?
« Reply #1324 on: March 07, 2017, 10:50:42 AM »
I wouldn't get too caught up on trying to figure out what this plan will mean to you. The plan is not being received well by, well, just about anyone.

boarder42

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Re: What comes after the ACA?
« Reply #1325 on: March 07, 2017, 10:54:41 AM »
in any other form of insurance you pay based on your risk profile.  older people are riskier and cost more i like the fact that they

Really?  Because it seems to me that my employer sponsored health insurance works really well, and it charges the same flat rate to every enrollee regardless of their risk profile.  That's what makes group insurance work.

If you're going to charge more to people who use more, why not just go all the way and charge everyone their actual costs?  That's not really insurance at all, is it?  Is that the model were moving towards here?

yeah a fucking group plan for HEALTH insurance.  in car insurance if you ahve more wrecks or are younger or really old your premiums go up.  if you drive alot your premiums are higher etc.  if you have alot of home insurance claims that goes up.

way to cherry pick my one comment to try to disagree with it. 

the aca health plan choices sucked ... they were incredibly awful my healthcare premiums would have run over 7k a year with insane deductibles.  i'd have moved on to healthshare ... where i dont have to subsidize the overweight smokers. 

and let me guess your work plan includes monetary benefit for being in weight range and not smoking... try to institute that at a national level  wont fly at all. 

i'm all for actual costs.  get rid of the insurance red tape let me pay the doctor i need to use but let me buy a what if i get cancer plan.  have the govt provide one physical/other preventative based on age per year in the form of a tax credit and move on.
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sol

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Re: What comes after the ACA?
« Reply #1326 on: March 07, 2017, 10:57:01 AM »
So if your income is under the 75/150k cutoff, you get the entire credit right?

Doesn't matter if I make only $20,000/year, so long as I buy insurance for $2,500 I will get the whole $2,500?

Yes, if you could buy insurance for 2500.  The problem is that without cost controls, these new lower subsidies for poor people will make them unable to buy insurance at all, and they will be forced to go without.

The fixed subsidies are higher than the ACA subsidies for some middle class families who were phased out of ACA subsidies, infinitely higher for people above 400% of the FPL who previously got no ACA subsidy, and lower for the poorest people.

Basically they just shifted the entitlements away from the poorest people, so they will lose coverage, and towards richer people, who will now pay less.  If you are rich, particularly if you make more than 250k/yr, the GOP plan is a great deal for you.  Of course, you already had insurance.
« Last Edit: March 07, 2017, 11:07:51 AM by sol »

Davids

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Re: What comes after the ACA?
« Reply #1327 on: March 07, 2017, 10:57:26 AM »
From a mustachian perspective I see this change as great for mustachians. Tax credits and increase in HSAAX. This plan is by no means great overall but it is better than the ACA and as mustachians it is great for us.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1328 on: March 07, 2017, 11:01:29 AM »
From a mustachian perspective I see this change as great for mustachians. Tax credits and increase in HSAAX. This plan is by no means great overall but it is better than the ACA and as mustachians it is great for us.

It is great if you don't ever get really sick.

Paul der Krake

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Re: What comes after the ACA?
« Reply #1329 on: March 07, 2017, 11:02:27 AM »
So if your income is under the 75/150k cutoff, you get the entire credit right?

Doesn't matter if I make only $20,000/year, so long as I buy insurance for $2,500 I will get the whole $2,500?
It is funny that you think you can get health insurance for $2500/year.
The WA health plan finder has a couple bronze options for a couple in their 30s that is just under $5,000/year, so it's very much in the cards right now.

BeanCounter

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Re: What comes after the ACA?
« Reply #1330 on: March 07, 2017, 11:03:24 AM »
From a mustachian perspective I see this change as great for mustachians. Tax credits and increase in HSAAX. This plan is by no means great overall but it is better than the ACA and as mustachians it is great for us.

I don't know about that. We were planning to use the ACA to purchase insurance until we are Medicare eligible. But now it looks like every year into retirement could get infinitely more expensive as premiums will be age (and risk?) based. ACA gave larger subsidies for the older members to buy better (silver) coverage.

brooklynguy

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Re: What comes after the ACA?
« Reply #1331 on: March 07, 2017, 11:04:02 AM »
From a mustachian perspective I see this change as great for mustachians. Tax credits and increase in HSAAX. This plan is by no means great overall but it is better than the ACA and as mustachians it is great for us.

The prototypical retired mustachian's financial profile approximates that of the average low-income American,* which makes this plan much worse than the ACA from his or her perspective.

*EDIT:  From the perspective, that is, of the ACA and the proposed new legislation, which both include income tests but ignore net worth.
« Last Edit: March 07, 2017, 11:12:20 AM by brooklynguy »

sol

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Re: What comes after the ACA?
« Reply #1332 on: March 07, 2017, 11:07:15 AM »
yeah a fucking group plan for HEALTH insurance...
way to cherry pick my one comment to try to disagree with it. 

Aren't we talking about health insurance?  If you agree that group plans with equal premiums for all participants work well for health insurance, then we need not argue.

But I still disagree with your assessment that the ACA was failing.  Republicans have been repeating this line on television often, as their justification for needing to change the law, but it doesn't hold up under scrutiny.  The ACA has been seeing record sign ups, and lots of insurance companies have had to refund money to ratepayers because they exceeded the ACA profit caps.  Millions more people have insurance, the industry is profitable, and cost controls are working (slower than most of us would like, but still working).  Where is the evidence of failure?

sol

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Re: What comes after the ACA?
« Reply #1333 on: March 07, 2017, 11:16:55 AM »
So if your income is under the 75/150k cutoff, you get the entire credit right?

Doesn't matter if I make only $20,000/year, so long as I buy insurance for $2,500 I will get the whole $2,500?
It is funny that you think you can get health insurance for $2500/year.
The WA health plan finder has a couple bronze options for a couple in their 30s that is just under $5,000/year, so it's very much in the cards right now.

Those prices are after the current subsidy.  The subsidy will go down (for poor people) so the cost to consumers will be higher.

Don't be fooled.  When they offer you a $2500 subsidy, don't think that means you can buy a plan that currently costs 2500 and so get free insurance.  The plan actually costs much more than that, and is currently subsidized by the ACA.

Family health insurance typically costs 10-20k per year, depending on your age, assuming you are healthy.  Maybe your employer pays part of that, or maybe the ACA pays part of it, or maybe the new GOP plan pays part of it.  You will pay whatever is left.

geekette

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Re: What comes after the ACA?
« Reply #1334 on: March 07, 2017, 11:22:09 AM »
Our plan, 2 mid 50's, is $21,000/year. I'm afraid what they're going to go to when we're in our 60's.

sol

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Re: What comes after the ACA?
« Reply #1335 on: March 07, 2017, 11:22:37 AM »
From a mustachian perspective I see this change as great for mustachians. Tax credits and increase in HSAAX. This plan is by no means great overall but it is better than the ACA and as mustachians it is great for us.

The prototypical retired mustachian's financial profile approximates that of the average low-income American,* which makes this plan much worse than the ACA from his or her perspective.

*EDIT:  From the perspective, that is, of the ACA and the proposed new legislation, which both include income tests but ignore net worth.

I think the new GOP plan is better for the typical bogleheads retiree, and worse for the typical mustachian.

People on this site, who retiree early with very low apparent incomes, will see their insurance costs go up.  People from bogleheads, who retiree later in life and with a minimum of two million dollars, will probably pay less.

Iplawyer

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Re: What comes after the ACA?
« Reply #1336 on: March 07, 2017, 11:26:12 AM »

Like the rest of the population, most of Trump's supporters don't buy health insurance on the individual market. They believe this doesn't negatively impact them.

Are you sure?  The 1% is a very small population. Almost half the country voted for trump. A large portion of which are middle class.  These are the people that got fucked over the most with the ACA.  Even employer sponsored plans had to comply with ACA regulations.  Most employees pay more and get less benefits with higher deductibles.  These people are pissed off and want reform.  Unfortunately the republican plan does nothing about cost.  It is just shifting the burden on who pays for it.  It will also fail.

Apparently you weren't paying attention.  Only about half of the country voted at all.  And most of those voted for Hillary.

Paul der Krake

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Re: What comes after the ACA?
« Reply #1337 on: March 07, 2017, 11:29:38 AM »
So if your income is under the 75/150k cutoff, you get the entire credit right?

Doesn't matter if I make only $20,000/year, so long as I buy insurance for $2,500 I will get the whole $2,500?
It is funny that you think you can get health insurance for $2500/year.
The WA health plan finder has a couple bronze options for a couple in their 30s that is just under $5,000/year, so it's very much in the cards right now.

Those prices are after the current subsidy.  The subsidy will go down (for poor people) so the cost to consumers will be higher.

Don't be fooled.  When they offer you a $2500 subsidy, don't think that means you can buy a plan that currently costs 2500 and so get free insurance.  The plan actually costs much more than that, and is currently subsidized by the ACA.

Family health insurance typically costs 10-20k per year, depending on your age, assuming you are healthy.  Maybe your employer pays part of that, or maybe the ACA pays part of it, or maybe the new GOP plan pays part of it.  You will pay whatever is left.

Nope, the price I quoted is the price paid for a couple born in 1984 with no subsidies on bronze plans. Unless you are saying that the price is somehow subsidized by the ACA's existence?

I find that a little hard to believe, considering I have paid for non-ACA plans for less than that before the ACA came into effect. I understand the risk of death spirals if all the healthy people opt out, but isn't that what was going on before the ACA?

I have no reason to believe that a healthy couple won't be able to find insurance for $5k/year if this passes as is.

sol

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Re: What comes after the ACA?
« Reply #1338 on: March 07, 2017, 11:42:38 AM »
You're only quoting the premiums, not the total cost of the plan.  Premiums look cheap when deductibles and coinsurance and copays are high.

The ACA was designed to lower total costs, by subsidizing both premiums and out of pocket costs.  Let's try to compare apples to apples.

BeanCounter

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Re: What comes after the ACA?
« Reply #1339 on: March 07, 2017, 11:47:09 AM »
You're only quoting the premiums, not the total cost of the plan.  Premiums look cheap when deductibles and coinsurance and copays are high.

The ACA was designed to lower total costs, by subsidizing both premiums and out of pocket costs.  Let's try to compare apples to apples.

The ACA also had some basic coverage guidelines. Looks like that is going away too. So we won't be able to know if we are getting what we pay for without reading the entire SPD for each plan before you buy.

AdrianC

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Re: What comes after the ACA?
« Reply #1340 on: March 07, 2017, 12:23:20 PM »
But I still disagree with your assessment that the ACA was failing.  Republicans have been repeating this line on television often, as their justification for needing to change the law, but it doesn't hold up under scrutiny.  The ACA has been seeing record sign ups, and lots of insurance companies have had to refund money to ratepayers because they exceeded the ACA profit caps.  Millions more people have insurance, the industry is profitable, and cost controls are working (slower than most of us would like, but still working).  Where is the evidence of failure?
Well, insurance companies have been pulling out. There were many areas where only one company participated on the exchange for 2017.

accolay

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Re: What comes after the ACA?
« Reply #1341 on: March 07, 2017, 12:24:29 PM »
It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them. The government has been fucking over the middle class for way too long.

I always love this statement. An oldie, but a goodie. The Government. Who do you think votes for that Government? And then they complain that it's awful...wash and repeat.

Trump is just another idiot who thought (does he do that?) he could get into government because it's just so damned easy to fix these simple problems our country has and he had these terrific, just terrific talking points. But when it comes down to it the problems are difficult, with a lot of variables, and they have to satisfy a lot of different agendas finding out it's actually really hard to make positive change....but then, who knew "it could be so complicated."

Back to topic...can't wait until the CBO gives us a little love on this.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1342 on: March 07, 2017, 12:28:14 PM »
But I still disagree with your assessment that the ACA was failing.  Republicans have been repeating this line on television often, as their justification for needing to change the law, but it doesn't hold up under scrutiny.  The ACA has been seeing record sign ups, and lots of insurance companies have had to refund money to ratepayers because they exceeded the ACA profit caps.  Millions more people have insurance, the industry is profitable, and cost controls are working (slower than most of us would like, but still working).  Where is the evidence of failure?
Well, insurance companies have been pulling out. There were many areas where only one company participated on the exchange for 2017.

So you think that insurance companies pulling out of the ACA when they are getting $8,000 to $10,000 in subsidies from a poor family and somehow they are going to agree to stay in this new plan when they are only going to get $5,000 from the poor family?

If you think they are pulling out now, you ain't seen nothing yet.   If this new ACA plan hits, they won't even be climaxing.

jim555

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Re: What comes after the ACA?
« Reply #1343 on: March 07, 2017, 12:30:09 PM »
This plan will reduce the number of insured a great deal.  That will not help any insurance market.

golden1

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Re: What comes after the ACA?
« Reply #1344 on: March 07, 2017, 12:42:58 PM »
Quote
I always love this statement. An oldie, but a goodie. The Government. Who do you think votes for that Government? And then they complain that it's awful...wash and repeat.

Yep, it's like the "Government" is some sort of weird mysterious body of people that sprung out of the ground instead of, you know, consisting of people that were voted for and the people they hired.   Also, most people know government employees who aren't evil people and who go to work everyday and do their jobs.  My dad was one of those people. 

So far the roll out of this bill is going over like a lead balloon. 

jim555

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Re: What comes after the ACA?
« Reply #1345 on: March 07, 2017, 01:12:49 PM »
For an interactive map of ACA vs. Proposed plan by state, age and income:
http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/

skeinwinder

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Re: What comes after the ACA?
« Reply #1346 on: March 07, 2017, 01:25:13 PM »
We could be FIREd....

Speaking as someone who has had coverage from the ACA the past few years (but not this year, my husband's startup decided to offer insurance to "all both" FTEs)

I signed up for family ACA coverage for 2017 before we knew the insurance situation:
In our county (NC) the second lowest silver plan for our family (M57, F50, 15, 13) is approx 2200 per MONTH. This plan has a limited panel of doctors, a ~6000 per person deductible, 13K deductible per family. Copays. Essentially, aside from office visit/Rx copays, a typical family will receive little benefit until medical costs exceed either 500$/month for one person, or there is a catastrophic event.

There were two bronze HDHP plans. Both were approx 1800/mo. Deductible was the full ~6000. Once again, limited panel

If we had the maximum income to receive a subsidy, we would have paid approx 700/mo, for a subsidy of 1500 per month.

Now, let's assume the plan remains the same, and we have the Trumpcare subsidy: we would get about 1000 a month. So, we lose 'bigly'.

But here is the caveat: Last time I had to purchase insurance on the open market, I cost as much to insure as my husband (7 years older) and both kids all together. I saw nothing in the GOP plan to make it affordable to get insurance, so I'm assuming that we would have to go through underwriting, and our plan would go up substantially due to my mild, non-life threatening chronic conditions.

On top of this, the current ACA plan limits the ratio of premiums by age to 1:3, so a healthy 64yo will pay no more than three times what a new graduate pays. The new GOP plan changes this to 1:5. I expect that for those of us in our 50's and over, family premiums could easily reach 3500.

My husband doesn't see it yet, but we are FI, except for health care, college (nearly funded for 2x state schools, big ?? for private) and long term care costs. I had hoped he could call it quits in 2020 (when we will have some idea what college costs will be like), but if we have to plan on an additional 12K-15K or more in costs, that will add at least 3 years, even with our stache doing the heavy lifting.

 I'm being conservative, because my grandfather is 101 and still counting, and I had several other centenarian relatives. Self-Pay long term care costs for my grandfather to remain at home (no medical care, but mild dementia and general frailty) are over 75Kper year , plus household costs (VHCOL area). He and my now deceased grandmother ran through well over 1MM in savings, and that's just so far.





teen persuasion

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Re: What comes after the ACA?
« Reply #1347 on: March 07, 2017, 01:33:52 PM »
For an interactive map of ACA vs. Proposed plan by state, age and income:
http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/

Thanks for the link - very interesting how it changes based on age vs income vs state.

skeinwinder

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Re: What comes after the ACA?
« Reply #1348 on: March 07, 2017, 01:46:35 PM »
Quote
For an interactive map of ACA vs. Proposed plan by state, age and income:
http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/

Interesting, but it doesn't take into account household size, as best as I can tell. So if I put my husband in by himself, with his income, it looks like his tax credit it much larger, but if I put in a per-capita income, the entire state turns dark blue.

effigy98

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Re: What comes after the ACA?
« Reply #1349 on: March 07, 2017, 01:50:35 PM »
For an interactive map of ACA vs. Proposed plan by state, age and income:
http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/

Says net gain of $500 to $3000 in my area depending on if I am working or retired. The doubling of the HSA account limits sounds awesome too so i can sock away more tax free money. So far it seems pretty neutral and my fear of not being able to retire early has been reduced.