Author Topic: What comes after the ACA?  (Read 389736 times)

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2250 on: May 09, 2017, 11:42:10 AM »

Should a healthy 60-year-old making $150,000/yr receive subsidized premiums at the expense of a healthy 27-year-old making $60,000/yr?

the healthy 27 year old would have been putting 18K into his 401k, and 5.5K into his tIRA, so his adjusted gross income would now be $36,500 and he would now be getting subsidies for his health insurance, he would now be subsidized by rich people.

Jrr85

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Re: What comes after the ACA?
« Reply #2251 on: May 09, 2017, 11:42:49 AM »
Should a healthy 60-year-old making $150,000/yr receive subsidized premiums at the expense of a healthy 27-year-old making $60,000/yr?
A healthy sixty year old making $150k will not get subsidies because their income is too high. http://www.financialsamurai.com/subsidy-amounts-by-income-limits-for-the-affordable-care-act-obamacare/

They won't receive subsidies through the tax code.  They probably will get the subsidy from the prohibition from fully risk rating based on age. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2252 on: May 09, 2017, 11:44:34 AM »
So it's not that they don't start a business because of the price of health insurance, it's that they don't start a business because they can't stomach the cut in total compensation that would occur to begin with as a result of quitting their job and starting a new business.

I just don't think this is correct. Health insurance access is a main reason not to start new ventures.

tyort1

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Re: What comes after the ACA?
« Reply #2253 on: May 09, 2017, 11:45:47 AM »
I doubt it.  Most people that want to start businesses are relatively young and healthy.  Depending on the health of the pool of employees at their employer, they are probably healthier, and so even if they lose the benefit of the favorable tax treatment, it will still probably be roughly the same in costs if not cheaper.  So it's not that they don't start a business because of theprice of health insurance, it's that they don't start a business because they can't stomach the cut in total compensation that would occur to begin with as a result of quitting their job and starting a new business.

That's simply not true.  A large # of small business are 'consultants'.  Usually people that work in an industry for a big company, get experience and specialized knowledge, and then cut out on their own.  There's TONS of companies that get started by people specifically because the have experience and can leverage that to a good paying gig. 

In fact, I personally know several people that would love to cut loose from the megacorp I work for and can't because of the uncertainty with health insurance. 
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Jrr85

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Re: What comes after the ACA?
« Reply #2254 on: May 09, 2017, 11:48:11 AM »
Why is it necessary to go a step farther and force young people to pay for discounts to the older people who are doing well financially and don't need the tax credits?

It isn't necessary, and the ACA doesn't do that.  Older people who don't need the tax credits (okay "premium subsidies") don't get the tax credits.  Only poor people get the tax credits.  Premiums are limited to a percentage of your income, regardless of age.  The young do not pay more to subsidize the old; the rich pay more to subsidize the poor.

But some people will use any divisive tactic they can think of to turn people against each other.  Did you know that inner city black women are having kids left and right to take welfare benefits away from hard working poor white Americans?  Same BS logic.

The ACA does do that with its limits on age based risk rating.  And it's not the people pointing that out that are being divisive.  If anyone is being divisive, it's the people trying to shaft younger people for no reason other than they don't have the political clout of older people.  That's corrosive to civil society. 

Knaak

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Re: What comes after the ACA?
« Reply #2255 on: May 09, 2017, 11:52:43 AM »
Should a healthy 60-year-old making $150,000/yr receive subsidized premiums at the expense of a healthy 27-year-old making $60,000/yr?
A healthy sixty year old making $150k will not get subsidies because their income is too high. http://www.financialsamurai.com/subsidy-amounts-by-income-limits-for-the-affordable-care-act-obamacare/

It's not about the tax credits for being under 400% of FPL.  The subsidized premiums are due to the ratios changing from 5:1 to 3:1.  The 27-year-old now has to pay higher premiums and the 60-year-old pays lower premiums due to the ratio compression.

tyort1

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Re: What comes after the ACA?
« Reply #2256 on: May 09, 2017, 11:54:57 AM »
The ACA does do that with its limits on age based risk rating.  And it's not the people pointing that out that are being divisive.  If anyone is being divisive, it's the people trying to shaft younger people for no reason other than they don't have the political clout of older people.  That's corrosive to civil society.

That's true.  Older people do get more of a say than young people do.  That's because older people vote in much higher numbers than young people.  So that is who the politicians cater to.  It's been like this for ever.  It could change though.  Just need to get more young people to vote, then you'll see this power dynamic shift, right quick.
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BFGirl

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Re: What comes after the ACA?
« Reply #2257 on: May 09, 2017, 12:14:54 PM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.

It's this kind of thinking that destroys entrepreneurial ventures.
If people have to worry about not having health insurance if they leave a job at a staid megacorp to start a new business, then destroying the ACA will stunt the entrepreneurial spirit and new business formation.
It's the formation of new business that contribute most to economic activity and hiring of new employees.
Interesting point.  I'm fairly certain if we were to craft a health-care and tax system entirely from scratch, neither party would create a system which relies overwhelmingly on health care being provided by an individual's employer. This made some sense several generations ago when health care costs were relatively modest, worker mobility was low and government could encourage companies to provide health care by relatively small tax breaks.

In today's reality it does exactly what you say- stiffles entrepreneurial ventures and limits the success of small businesses . Health coverage has become an anchor for many employees.

It is an anchor for me.  I would likely quit today and concentrate on my side business if I didn't have to worry about health insurance.  I could take my pension payout later and use my savings to bridge the gap to 60, but I can't afford to bridge the gap until 65 for the health insurance.  If I stay a few more years my employer will pay  45-60% of my health insurance premiums.

mm1970

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Re: What comes after the ACA?
« Reply #2258 on: May 09, 2017, 12:51:36 PM »
Should a healthy 60-year-old making $150,000/yr receive subsidized premiums at the expense of a healthy 27-year-old making $60,000/yr?
A healthy sixty year old making $150k will not get subsidies because their income is too high. http://www.financialsamurai.com/subsidy-amounts-by-income-limits-for-the-affordable-care-act-obamacare/

It's not about the tax credits for being under 400% of FPL.  The subsidized premiums are due to the ratios changing from 5:1 to 3:1.  The 27-year-old now has to pay higher premiums and the 60-year-old pays lower premiums due to the ratio compression.
Well, but technically the 60 year old is still paying higher premiums, right?  I mean, correct me if I'm wrong (because I haven't researched it).

The 5:1 and 3:1 means

27 year old pays $5k a year premiums (or whatever)
60 year old pays $15k a year premiums (instead of $25k)

Jrr85

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Re: What comes after the ACA?
« Reply #2259 on: May 09, 2017, 01:08:39 PM »
So it's not that they don't start a business because of the price of health insurance, it's that they don't start a business because they can't stomach the cut in total compensation that would occur to begin with as a result of quitting their job and starting a new business.

I just don't think this is correct. Health insurance access is a main reason not to start new ventures.

Again, maybe in some cases, but most people that want to start businesses are relatively young and relatively healthy.  So in most cases, they could get insurance on the private market before Obamacare that was roughly in line with what the total cost of their employer provided insurance was.  It's the actual compensation that was preventing them from quitting and starting a busienss, not access to insurance.   I'm sure there were plenty of individuals who were sick or who had a spouse or dependent that was sick where the price differential between employer provided insurance and insurance on the individual market was an issue, but I don't think that was anywhere near a primary driver and there's nothing in the data since obamacare to suggest that it was. 

NESailor

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Re: What comes after the ACA?
« Reply #2260 on: May 09, 2017, 01:15:59 PM »
So it's not that they don't start a business because of the price of health insurance, it's that they don't start a business because they can't stomach the cut in total compensation that would occur to begin with as a result of quitting their job and starting a new business.

I just don't think this is correct. Health insurance access is a main reason not to start new ventures.

Again, maybe in some cases, but most people that want to start businesses are relatively young and relatively healthy.  So in most cases, they could get insurance on the private market before Obamacare that was roughly in line with what the total cost of their employer provided insurance was.  It's the actual compensation that was preventing them from quitting and starting a busienss, not access to insurance.   I'm sure there were plenty of individuals who were sick or who had a spouse or dependent that was sick where the price differential between employer provided insurance and insurance on the individual market was an issue, but I don't think that was anywhere near a primary driver and there's nothing in the data since obamacare to suggest that it was.

I read somewhere that most businesses are started by people who are around 40 years old.  I am adding nothing to the rest of this because it's mostly speculation. 

Personal example - I gave up on joining a startup because they haven't gotten their health insurance thing sorted and my wife's employer (basically a church) didn't offer good coverage at a decent price (we had kids already).  It was unique in that the startup was in the medical field (go figure) and almost all employees had coverage from a MEGAmega corp that closed a plant locally.  They had no real incentive to look for coverage for a young finance dude when everyone else was already covered.  Crap luck I guess.  They signed a billion dollar contract for their unique product a few months ago...

Orvell

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Re: What comes after the ACA?
« Reply #2261 on: May 09, 2017, 01:18:11 PM »
I was resisting posting here, because UUF this thread.

But I need to push back.

Jrr85


Young and healthy /= entrepreneurs. Did you stop to think that maybe the REASON you have this idea of most entrepreneurs being young and healthy might be because our health care system makes anything else Very Risky? Young and healthy people can absorb that risk with greater ease.
A person with a family, or major (or even minor!) health considerations can't make the same leap of faith as a healthy person who is young and without familial responsibility. It's not that young healthy people are magically better entrepreneurs... it's simply that because of our country right now, that's the group of people who are able to do that and not ruin themselves.

In sum
: you're seeing it backwards. The trends you are identifying are vestiges of the pre-ACA world and (apparently utterly valid) fear of returning to that world.
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rantk81

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Re: What comes after the ACA?
« Reply #2262 on: May 09, 2017, 01:59:25 PM »

This confuses me though.  I'm middle-aged.  I've been paying health insurance premiums, and certainly have used less health care than I've paid for, in my 25 years as an adult.

So, in essence, wasn't I subsidizing older/ less healthy people all these years?  The same way that I've been subsidizing poorer drivers?

That's kind of the point of insurance.
Sure, the system is changing a bit, I get that.

I think I'd be really pissed if I paid insurance premiums for 38 years, barely used insurance, then got cancer at 60 or got into a bad car accident and suddenly had my premiums skyrocket "because you are old and sick or old and injured".  That's kind of shitty.

+1000000000

That's the problem with jacking up the price for older folks. I'm in my mid-30s, and ever since graduating from school, I've been under a group policy at my employer that charges the same price, regardless of age.  I've paid (or had my employer pay on my behalf) WAY WAY WAY more into the "insurance health care system" than the cost of care that I have received thus far. I would be super-pissed if my rates were jacked up to unaffordable levels (not if, but) when I finally need some medical care. I will also be super pissed if developed a medical condition and then lost my employer sponsored coverage, and then would be unable to buy any plan, or any plan within a reasonable price.

This whole system is fucked.  We need to nuke it from orbit and offer a government single payer option to everyone. Health insurance and health care should be completely decoupled from employment. What a disaster.

« Last Edit: May 09, 2017, 02:04:33 PM by rantk81 »

Jrr85

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Re: What comes after the ACA?
« Reply #2263 on: May 09, 2017, 03:08:18 PM »
I was resisting posting here, because UUF this thread.

But I need to push back.

Jrr85


Young and healthy /= entrepreneurs. Did you stop to think that maybe the REASON you have this idea of most entrepreneurs being young and healthy might be because our health care system makes anything else Very Risky? Young and healthy people can absorb that risk with greater ease.
A person with a family, or major (or even minor!) health considerations can't make the same leap of faith as a healthy person who is young and without familial responsibility. It's not that young healthy people are magically better entrepreneurs... it's simply that because of our country right now, that's the group of people who are able to do that and not ruin themselves.

In sum
: you're seeing it backwards. The trends you are identifying are vestiges of the pre-ACA world and (apparently utterly valid) fear of returning to that world.

That's possible, but it seems more likely to me that most people when they are in their 50's do not decide, after decades of working for other people and entering their highest earning years, to decide that it's the right time to start a business and risk everything.  I also think that the people desiring to take on the challenge to start a new business are typically going to have high energy and not facing health issues. 

Again, you have spouses and dependents that may tie people to jobs for health insurance and there will certainly be plenty of examples of older or sicker people who actually do go out and start up a business, but I'm just not sure that's really a major driver.  People don't start businesses because they are risk averse, and people that are risk averse are going to particularly value a steady paycheck and employer provided insurance.   

None of that is to say that having insurance tied to employment makes sense; it doesn't.  I'm just saying there's not some wave of small business formation that's being held back by the inability to get insurance.  There are almost certainly some instances and that matters; but it's not the issue some people make it out to be.   

Orvell

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Re: What comes after the ACA?
« Reply #2264 on: May 09, 2017, 03:15:05 PM »
[snip...] I'm just saying there's not some wave of small business formation that's being held back by the inability to get insurance.  There are almost certainly some instances and that matters; but it's not the issue some people make it out to be.   

Except there absolutely is.
I only have anecdotal data (and it sounds like that's all you have too, so it's one anecdote versus another, which becomes just silly) but I know of plenty of people who would be risk tolerant enough to be full-time artists of some variety or another, but not with the health care/insurance situation as it is now. There's a difference between risking your earning potential for a year or two while you try out being in business for yourself, versus risking your entire net worth and health if you can't get insurance and access to the care you need. I'm saying that the former category of risk tolerant people who might be entrepreneurs is larger than the young and healthy.
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tyort1

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Re: What comes after the ACA?
« Reply #2265 on: May 09, 2017, 03:18:58 PM »
[snip...] I'm just saying there's not some wave of small business formation that's being held back by the inability to get insurance.  There are almost certainly some instances and that matters; but it's not the issue some people make it out to be.   

Except there absolutely is.
I only have anecdotal data (and it sounds like that's all you have too, so it's one anecdote versus another, which becomes just silly) but I know of plenty of people who would be risk tolerant enough to be full-time artists of some variety or another, but not with the health care/insurance situation as it is now. There's a difference between risking your earning potential for a year or two while you try out being in business for yourself, versus risking your entire net worth and health if you can't get insurance and access to the care you need. I'm saying that the former category of risk tolerant people who might be entrepreneurs is larger than the young and healthy.
This is exactly my experience too.  Maybe Jrr85 is young and doesn't have any peers that are in their 40's and 50's? 
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nereo

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Re: What comes after the ACA?
« Reply #2266 on: May 09, 2017, 03:25:43 PM »

That's possible, but it seems more likely to me that most people when they are in their 50's do not decide, after decades of working for other people and entering their highest earning years, to decide that it's the right time to start a business and risk everything.  I also think that the people desiring to take on the challenge to start a new business are typically going to have high energy and not facing health issues. 

Here's some actual facts to go with the discussion: Successful startups are most frequently started by those in their 40's and 50s.

Quote
we found that the typical successful founder was 40 years old, with at least 6-10 years of industry experience. Twice as many successful entrepreneurs are more than 50 as under 25.

The reasons are pretty straight-forward - people who are in their 40s have personal capitol they can invest, business experience and their children have grown into adults.  Of course all of these are put into jeopardy if those individuals cannot afford health insurance and are tied to jobs at large employers.

Source
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BFGirl

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Re: What comes after the ACA?
« Reply #2267 on: May 09, 2017, 03:59:53 PM »
I was resisting posting here, because UUF this thread.

But I need to push back.

Jrr85


Young and healthy /= entrepreneurs. Did you stop to think that maybe the REASON you have this idea of most entrepreneurs being young and healthy might be because our health care system makes anything else Very Risky? Young and healthy people can absorb that risk with greater ease.
A person with a family, or major (or even minor!) health considerations can't make the same leap of faith as a healthy person who is young and without familial responsibility. It's not that young healthy people are magically better entrepreneurs... it's simply that because of our country right now, that's the group of people who are able to do that and not ruin themselves.

In sum
: you're seeing it backwards. The trends you are identifying are vestiges of the pre-ACA world and (apparently utterly valid) fear of returning to that world.

That's possible, but it seems more likely to me that most people when they are in their 50's do not decide, after decades of working for other people and entering their highest earning years, to decide that it's the right time to start a business and risk everything.  I also think that the people desiring to take on the challenge to start a new business are typically going to have high energy and not facing health issues. 

Again, you have spouses and dependents that may tie people to jobs for health insurance and there will certainly be plenty of examples of older or sicker people who actually do go out and start up a business, but I'm just not sure that's really a major driver.  People don't start businesses because they are risk averse, and people that are risk averse are going to particularly value a steady paycheck and employer provided insurance.   

None of that is to say that having insurance tied to employment makes sense; it doesn't.  I'm just saying there's not some wave of small business formation that's being held back by the inability to get insurance.  There are almost certainly some instances and that matters; but it's not the issue some people make it out to be.

I am about to be 50 and would absolutely work on my side business and try to grow it if I didn't have the specter of whether or not I could afford health insurance hanging over my head.

tyort1

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Re: What comes after the ACA?
« Reply #2268 on: May 09, 2017, 05:37:08 PM »
It'll be interesting if Jrr85 changes his views in light of this info.  I find often that people cannot because it might undermine other, more basic ideas.  Like, if you think the ACA is bad, you have a tough time acknowledging that there might be some benefits to it, like encouraging people to start small businesses. 

Often times I see people arguing about these secondary points endlessly, because they are really just a proxy for the deeper idea of whether the ACA is beneficial or not. 
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JLee

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Re: What comes after the ACA?
« Reply #2269 on: May 09, 2017, 09:37:28 PM »
It'll be interesting if Jrr85 changes his views in light of this info.  I find often that people cannot because it might undermine other, more basic ideas.  Like, if you think the ACA is bad, you have a tough time acknowledging that there might be some benefits to it, like encouraging people to start small businesses. 

Often times I see people arguing about these secondary points endlessly, because they are really just a proxy for the deeper idea of whether the ACA is beneficial or not.

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tyort1

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Re: What comes after the ACA?
« Reply #2270 on: May 09, 2017, 11:54:59 PM »
It'll be interesting if Jrr85 changes his views in light of this info.  I find often that people cannot because it might undermine other, more basic ideas.  Like, if you think the ACA is bad, you have a tough time acknowledging that there might be some benefits to it, like encouraging people to start small businesses. 

Often times I see people arguing about these secondary points endlessly, because they are really just a proxy for the deeper idea of whether the ACA is beneficial or not.

http://theoatmeal.com/comics/believe

Hot damn, that was awesome!  Thanks.
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JLee

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Re: What comes after the ACA?
« Reply #2271 on: May 10, 2017, 12:02:22 AM »
It'll be interesting if Jrr85 changes his views in light of this info.  I find often that people cannot because it might undermine other, more basic ideas.  Like, if you think the ACA is bad, you have a tough time acknowledging that there might be some benefits to it, like encouraging people to start small businesses. 

Often times I see people arguing about these secondary points endlessly, because they are really just a proxy for the deeper idea of whether the ACA is beneficial or not.

http://theoatmeal.com/comics/believe

Hot damn, that was awesome!  Thanks.

It's seriously one of the best things, if not the best thing I have read all year.

AdrianC

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Re: What comes after the ACA?
« Reply #2272 on: May 10, 2017, 06:43:06 AM »
It'll be interesting if Jrr85 changes his views in light of this info.  I find often that people cannot because it might undermine other, more basic ideas.  Like, if you think the ACA is bad, you have a tough time acknowledging that there might be some benefits to it, like encouraging people to start small businesses. 

Often times I see people arguing about these secondary points endlessly, because they are really just a proxy for the deeper idea of whether the ACA is beneficial or not.

http://theoatmeal.com/comics/believe

Oh no! More excellent comics. That's my day shot.

boarder42

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Re: What comes after the ACA?
« Reply #2273 on: May 10, 2017, 06:49:50 AM »
It'll be interesting if Jrr85 changes his views in light of this info.  I find often that people cannot because it might undermine other, more basic ideas.  Like, if you think the ACA is bad, you have a tough time acknowledging that there might be some benefits to it, like encouraging people to start small businesses. 

Often times I see people arguing about these secondary points endlessly, because they are really just a proxy for the deeper idea of whether the ACA is beneficial or not.

http://theoatmeal.com/comics/believe

Hot damn, that was awesome!  Thanks.

It's seriously one of the best things, if not the best thing I have read all year.

thats really good i feel it will affect me for all of a week and then i'll forget about it and build bigger walls
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Jrr85

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Re: What comes after the ACA?
« Reply #2274 on: May 10, 2017, 11:22:11 AM »

That's possible, but it seems more likely to me that most people when they are in their 50's do not decide, after decades of working for other people and entering their highest earning years, to decide that it's the right time to start a business and risk everything.  I also think that the people desiring to take on the challenge to start a new business are typically going to have high energy and not facing health issues. 

Here's some actual facts to go with the discussion: Successful startups are most frequently started by those in their 40's and 50s.

Quote
we found that the typical successful founder was 40 years old, with at least 6-10 years of industry experience. Twice as many successful entrepreneurs are more than 50 as under 25.

The reasons are pretty straight-forward - people who are in their 40s have personal capitol they can invest, business experience and their children have grown into adults.  Of course all of these are put into jeopardy if those individuals cannot afford health insurance and are tied to jobs at large employers.

Source

That's data looking at successful startups, so I'm not sure that is applicable.  Even then, it says the typical founder is 40.  Not really at an age yet where health conditions make health insurance unaffordable. 

And since the linked study on health insurance is gated, it's hard to tell whether it's applicable or not.  Anecdotally (which is obviously not data), when most people talk about being tied to insurance, what they are really talking about is compensation.  It's typically not that they are unhealthy and that their insurance in the private market would be thousands of dollars more than what their employer provided plan costs. 

It's that they are getting a lot of compensation in the form of health insurance, and when they look at giving up that compensation, they are too risk averse to make the leap.  People say that it's insurance, and I have seen "studies" repeat that claim, but if you look at what people are actually saying, it's that the cut in compensation would be too much for them to start their own business.  They mentally isolate the compensation in the form of the portion of health insurance premiums covered by their employer and claim it's an insurance issue; but it's not an insurance issue, it's a compensation issue.  This obviously doesn't apply to the people that actually have health issues or spouses or dependents with health issues that would make health insurance a lot more expensive if they left their employer.  Those people exist.  I just haven't seen anything to indicate it's some huge number outside of survey results which don't ask the correct question. 

And even if someone does ask the question correctly, I think you'd still have to adjust the results downward because lots of people that actually would have issues with health insurance if they started their own business, would still find another reason to not start their own business if that obstacle went way (although i don't know how you'd get a feel for what the magnitude of the adjustment should be).   

 ETA:  http://www.kauffman.org/~/media/kauffman_org/research%20reports%20and%20covers/2015/05/kauffman_index_startup_activity_national_trends_2015.pdf

If you look at Figure 5, it looks like whatever change in startups by age that might be caused by insurance or the lack thereof is dwarfed by the tracking it does with the general health of the economy.  You could make an argument that the percentage of entrepeneurs would creep up with age if it weren't for insurance issues or you could make the argument that entrepreneurship doesn't creep up because even as people get in better position to start companies, they become more risk averse.     
« Last Edit: May 10, 2017, 11:32:50 AM by Jrr85 »

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Re: What comes after the ACA?
« Reply #2275 on: May 10, 2017, 11:41:35 AM »
Speaking from my own experience, my DH and are both 39 with no medical conditions. We would like to pursue consulting (along with FIRE). However we have two kids. Health Insurance premiums for healthy families is still quite expensive. We'd basically be trying to cover a mortgage each month. If everything goes well, our kids will be off our insurance in say 10 to 16 years. But then you have the fear that our rates could start to increase further as we age. We'd have to cover unknown premiums with unknown income for 25 years. Pretty scary.

Jrr85, you honestly have no idea what you are talking about. Lack of affordable individual or family health insurance will keep many people like DH and I in the workforce long past our desire. Which has a negative affect on the economy. I'd very much like to retire  or semi retire and give my high paying job to someone younger. But because of healthcare we'll keep chugging along....

tyort1

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Re: What comes after the ACA?
« Reply #2276 on: May 10, 2017, 11:56:45 AM »
Speaking from my own experience, my DH and are both 39 with no medical conditions. We would like to pursue consulting (along with FIRE). However we have two kids. Health Insurance premiums for healthy families is still quite expensive. We'd basically be trying to cover a mortgage each month. If everything goes well, our kids will be off our insurance in say 10 to 16 years. But then you have the fear that our rates could start to increase further as we age. We'd have to cover unknown premiums with unknown income for 25 years. Pretty scary.

Jrr85, you honestly have no idea what you are talking about. Lack of affordable individual or family health insurance will keep many people like DH and I in the workforce long past our desire. Which has a negative affect on the economy. I'd very much like to retire  or semi retire and give my high paying job to someone younger. But because of healthcare we'll keep chugging along....

Interestingly enough, The Oatmeal exactly predicted Jrr85's behavior.  I'll repost it because it's so awesome:

http://theoatmeal.com/comics/believe
Frugalite in training.

boarder42

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Re: What comes after the ACA?
« Reply #2277 on: May 10, 2017, 12:11:15 PM »
Speaking from my own experience, my DH and are both 39 with no medical conditions. We would like to pursue consulting (along with FIRE). However we have two kids. Health Insurance premiums for healthy families is still quite expensive. We'd basically be trying to cover a mortgage each month. If everything goes well, our kids will be off our insurance in say 10 to 16 years. But then you have the fear that our rates could start to increase further as we age. We'd have to cover unknown premiums with unknown income for 25 years. Pretty scary.

Jrr85, you honestly have no idea what you are talking about. Lack of affordable individual or family health insurance will keep many people like DH and I in the workforce long past our desire. Which has a negative affect on the economy. I'd very much like to retire  or semi retire and give my high paying job to someone younger. But because of healthcare we'll keep chugging along....

yes its mildly scary but can be planned for.  you dont just work indefinitely b/c "i dunno"  i agree we're in a state of overpriced flux right now but you can use healthshare and if you want the added insurance get a catostrophic plan.  this is a known cost of around 6k a year. 
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protostache

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Re: What comes after the ACA?
« Reply #2278 on: May 10, 2017, 12:17:06 PM »
Jrr85, I was uninsurable on the individual market before 2014. See, I had the unfortunate luck of developing testicular cancer in 2012. I had surgery and chemo and fully recovered and today I have an amazing 10 month old daughter. This is not the type of cancer that has a "cause". It just happens, to 5.7 men per 100,000 men per year. That's 8,550 additional men (and younger boys, actually) every year that would be uninsurable without the ban on medical underwriting.

In September 2014 I started working full time in my consulting business specifically because I could get a health insurance on the individual market. Now that my wife and I have a daughter to support, if AHCA or something like it proceeds all the way through to Trump's desk, I will be forced to close up my business and go work for a large corporation that provides large group health insurance. I know of at least 50 people that are in the exact same position I'm in. We're not uncommon.

mm1970

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Re: What comes after the ACA?
« Reply #2279 on: May 10, 2017, 12:20:41 PM »

That's possible, but it seems more likely to me that most people when they are in their 50's do not decide, after decades of working for other people and entering their highest earning years, to decide that it's the right time to start a business and risk everything.  I also think that the people desiring to take on the challenge to start a new business are typically going to have high energy and not facing health issues. 

Here's some actual facts to go with the discussion: Successful startups are most frequently started by those in their 40's and 50s.

Quote
we found that the typical successful founder was 40 years old, with at least 6-10 years of industry experience. Twice as many successful entrepreneurs are more than 50 as under 25.

The reasons are pretty straight-forward - people who are in their 40s have personal capitol they can invest, business experience and their children have grown into adults.  Of course all of these are put into jeopardy if those individuals cannot afford health insurance and are tied to jobs at large employers.

Source
This makes a lot of sense because (*anecdote alert*), I'm in my late 40's, and the self-employed and entrepreneurs I know are all the same, 40-60.

Some own their own businesses.
Some quit their jobs to be contractors.

I also know a handful of people who are contract workers because they are "too expensive" - being 60+, it can be hard to get hired into a full time job.

mm1970

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Re: What comes after the ACA?
« Reply #2280 on: May 10, 2017, 12:21:35 PM »
It'll be interesting if Jrr85 changes his views in light of this info.  I find often that people cannot because it might undermine other, more basic ideas.  Like, if you think the ACA is bad, you have a tough time acknowledging that there might be some benefits to it, like encouraging people to start small businesses. 

Often times I see people arguing about these secondary points endlessly, because they are really just a proxy for the deeper idea of whether the ACA is beneficial or not.

http://theoatmeal.com/comics/believe

Hot damn, that was awesome!  Thanks.
A friend of mine shared this last week.

boarder42

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Re: What comes after the ACA?
« Reply #2281 on: May 10, 2017, 12:21:49 PM »
Jrr85, I was uninsurable on the individual market before 2014. See, I had the unfortunate luck of developing testicular cancer in 2012. I had surgery and chemo and fully recovered and today I have an amazing 10 month old daughter. This is not the type of cancer that has a "cause". It just happens, to 5.7 men per 100,000 men per year. That's 8,550 additional men (and younger boys, actually) every year that would be uninsurable without the ban on medical underwriting.

In September 2014 I started working full time in my consulting business specifically because I could get a health insurance on the individual market. Now that my wife and I have a daughter to support, if AHCA or something like it proceeds all the way through to Trump's desk, I will be forced to close up my business and go work for a large corporation that provides large group health insurance. I know of at least 50 people that are in the exact same position I'm in. We're not uncommon.

to be devils advocate you're talking about .0057% of men in america who could be in the exact same situation as you(using your numbers).  not saying you should be uninsurable just saying add that to the fact that they are entreprenuers too.  i bet its cut by 2 or 3 more magnitudes of 10.   

this is the definition of uncommon
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Jrr85

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Re: What comes after the ACA?
« Reply #2282 on: May 10, 2017, 12:22:17 PM »
Speaking from my own experience, my DH and are both 39 with no medical conditions. We would like to pursue consulting (along with FIRE). However we have two kids. Health Insurance premiums for healthy families is still quite expensive. We'd basically be trying to cover a mortgage each month. If everything goes well, our kids will be off our insurance in say 10 to 16 years. But then you have the fear that our rates could start to increase further as we age. We'd have to cover unknown premiums with unknown income for 25 years. Pretty scary.

Jrr85, you honestly have no idea what you are talking about. Lack of affordable individual or family health insurance will keep many people like DH and I in the workforce long past our desire. Which has a negative affect on the economy. I'd very much like to retire  or semi retire and give my high paying job to someone younger. But because of healthcare we'll keep chugging along....

If you're health insurance in the private market would only be a mortgage payment each month, you may be agreeing with me depending on what you are calling a mortgage payment.  Most employer provided plans for a family of four will cost as much or more than a mortgage payment. 

The issue is different if you're talking about retiring in say the late 50's as opposed to the age of medicare eligibility.  At that point, people probably are benefiting significantly from being in a risk pool with their co-workers and families.   

boarder42

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Re: What comes after the ACA?
« Reply #2283 on: May 10, 2017, 12:25:27 PM »
Speaking from my own experience, my DH and are both 39 with no medical conditions. We would like to pursue consulting (along with FIRE). However we have two kids. Health Insurance premiums for healthy families is still quite expensive. We'd basically be trying to cover a mortgage each month. If everything goes well, our kids will be off our insurance in say 10 to 16 years. But then you have the fear that our rates could start to increase further as we age. We'd have to cover unknown premiums with unknown income for 25 years. Pretty scary.

Jrr85, you honestly have no idea what you are talking about. Lack of affordable individual or family health insurance will keep many people like DH and I in the workforce long past our desire. Which has a negative affect on the economy. I'd very much like to retire  or semi retire and give my high paying job to someone younger. But because of healthcare we'll keep chugging along....

If you're health insurance in the private market would only be a mortgage payment each month, you may be agreeing with me depending on what you are calling a mortgage payment.  Most employer provided plans for a family of four will cost as much or more than a mortgage payment. 

The issue is different if you're talking about retiring in say the late 50's as opposed to the age of medicare eligibility.  At that point, people probably are benefiting significantly from being in a risk pool with their co-workers and families.   

this is very true.  I just talked to my boss about this and our fantastic insurance we provide here will cost him and his wife 24,000 a year once he retires to just buy into the group plan. 

again people cost is the issue paying for 24k a year is bat shit overpriced insanity for a what if i get cancer scenario or just to be covered b/c of presicription drugs.
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Jrr85

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Re: What comes after the ACA?
« Reply #2284 on: May 10, 2017, 12:28:08 PM »
[snip...] I'm just saying there's not some wave of small business formation that's being held back by the inability to get insurance.  There are almost certainly some instances and that matters; but it's not the issue some people make it out to be.   

Except there absolutely is.
I only have anecdotal data (and it sounds like that's all you have too, so it's one anecdote versus another, which becomes just silly) but I know of plenty of people who would be risk tolerant enough to be full-time artists of some variety or another, but not with the health care/insurance situation as it is now. There's a difference between risking your earning potential for a year or two while you try out being in business for yourself, versus risking your entire net worth and health if you can't get insurance and access to the care you need. I'm saying that the former category of risk tolerant people who might be entrepreneurs is larger than the young and healthy.

I am arguing anecdotally and making a guess based on what seems to be fairly common human behavior from what I've seen. 

Again, I know plenty of people that claim they can't go off on their own because they "can't get insurance."  Some of those people have actual health issues (or spouses or dependents with health issuse) and they really do need the benefit of being in an employer plan.  But most people that say that are really saying it would cost them $12 to 18k a year for insurance, when that is basically what they are already paying, they just don't realize it because it's not part of their cash compensation. 

protostache

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Re: What comes after the ACA?
« Reply #2285 on: May 10, 2017, 12:39:24 PM »
Jrr85, I was uninsurable on the individual market before 2014. See, I had the unfortunate luck of developing testicular cancer in 2012. I had surgery and chemo and fully recovered and today I have an amazing 10 month old daughter. This is not the type of cancer that has a "cause". It just happens, to 5.7 men per 100,000 men per year. That's 8,550 additional men (and younger boys, actually) every year that would be uninsurable without the ban on medical underwriting.

In September 2014 I started working full time in my consulting business specifically because I could get a health insurance on the individual market. Now that my wife and I have a daughter to support, if AHCA or something like it proceeds all the way through to Trump's desk, I will be forced to close up my business and go work for a large corporation that provides large group health insurance. I know of at least 50 people that are in the exact same position I'm in. We're not uncommon.

to be devils advocate you're talking about .0057% of men in america who could be in the exact same situation as you(using your numbers).  not saying you should be uninsurable just saying add that to the fact that they are entreprenuers too.  i bet its cut by 2 or 3 more magnitudes of 10.   

this is the definition of uncommon

That's fair. My point is that people who are uninsurable in a world with medical underwriting are common, not that people with my specific condition are common. Those people are more likely to attempt to start businesses if they know they can get health insurance without going through a large group plan.

boarder42

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Re: What comes after the ACA?
« Reply #2286 on: May 10, 2017, 12:48:18 PM »
Jrr85, I was uninsurable on the individual market before 2014. See, I had the unfortunate luck of developing testicular cancer in 2012. I had surgery and chemo and fully recovered and today I have an amazing 10 month old daughter. This is not the type of cancer that has a "cause". It just happens, to 5.7 men per 100,000 men per year. That's 8,550 additional men (and younger boys, actually) every year that would be uninsurable without the ban on medical underwriting.

In September 2014 I started working full time in my consulting business specifically because I could get a health insurance on the individual market. Now that my wife and I have a daughter to support, if AHCA or something like it proceeds all the way through to Trump's desk, I will be forced to close up my business and go work for a large corporation that provides large group health insurance. I know of at least 50 people that are in the exact same position I'm in. We're not uncommon.

to be devils advocate you're talking about .0057% of men in america who could be in the exact same situation as you(using your numbers).  not saying you should be uninsurable just saying add that to the fact that they are entreprenuers too.  i bet its cut by 2 or 3 more magnitudes of 10.   

this is the definition of uncommon

That's fair. My point is that people who are uninsurable in a world with medical underwriting are common, not that people with my specific condition are common. Those people are more likely to attempt to start businesses if they know they can get health insurance without going through a large group plan.

probably more likely yes but the number of people starting and succeeding at business is also very small.. not that it doesnt advance things to allow people to not have to worry about the option.  but still it doesnt matter who the hell pays for it if its all over priced anyways.

i'm not for regulation but guess what the ER closest to you or your accident has a monopoly treat them like utilities regulate their allowable profit.  the way patents are given here allow drug companies to recoup costs.  well lets change it to allow to the company  recoup x% fixed rate from that drug then it goes to the free market and has caps.  So they dont have to worry about how many people use it or whatever you get to keep recouping and dominating your monopoly until you've gotten you money back.  how do we account for failed drugs i dont know but america is footing the research bill for the world with what we pay for everything.  until costs are brought into control federal subsidizing it is a F"n bandaid.
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brooklynguy

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Re: What comes after the ACA?
« Reply #2287 on: May 10, 2017, 01:02:42 PM »
people that say that are really saying it would cost them $12 to 18k a year for insurance, when that is basically what they are already paying, they just don't realize it because it's not part of their cash compensation.

Yes, this phenomenon (i.e., individuals being unaware of just how large a component of their total compensation employer-sponsored health insurance actually represents) has already been observed in this very thread.  And BeanCounter's post appears to be a perfect illustration of that phenomenon.

However, the government's subsidization of employer-sponsored health insurance (via exempting that form of compensation from taxation)--which, as nereo explained in the linked post, is ultimately what gave rise to the phenomenon in the first place--means that, all else being equal, insurance coverage purchased independently on the open market will, on an after-tax basis, cost an individual more than the total cost (employer-paid + employee-paid premiums) of identical employer-sponsored coverage (assuming that the individual is subject to some positive amount of tax liability).

nereo

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Re: What comes after the ACA?
« Reply #2288 on: May 10, 2017, 01:11:43 PM »
Yes, this phenomenon (i.e., individuals being unaware of just how large a component of their total compensation employer-sponsored health insurance actually represents) has already been observed in this very thread.  And BeanCounter's post appears to be a perfect illustration of that phenomenon.

However, the government's subsidization of employer-sponsored health insurance (via exempting that form of compensation from taxation)--which, as nereo explained in the linked post, is ultimately what gave rise to the phenomenon in the first place--means that, all else being equal, insurance coverage purchased independently on the open market will, on an after-tax basis, cost an individual more than the total cost (employer-paid + employee-paid premiums) of identical employer-sponsored coverage (assuming that the individual is subject to some positive amount of tax liability).
Has a 46 page thread run its course when the discussion can be linked back to comments made on page 8?
You decide...

Side note: what effect, if any, will the Comey firing have on the Senate's ability to vote on their health-care bill?  I'm guessing this drags everything to a crawl and nothing will emerge until at least July.  Reason: there's more than two GOPers who will be hesitant to push already an already wildly unpopular topic while this storm rages.  Reason2: The CBO will release their scoring in the next couple of days and I doubt it the headline numbers will be pretty.
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NESailor

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Re: What comes after the ACA?
« Reply #2289 on: May 10, 2017, 01:39:03 PM »


i'm not for regulation but guess what the ER closest to you or your accident has a monopoly treat them like utilities regulate their allowable profit. the way patents are given here allow drug companies to recoup costs.  well lets change it to allow to the company  recoup x% fixed rate from that drug then it goes to the free market and has caps.  So they dont have to worry about how many people use it or whatever you get to keep recouping and dominating your monopoly until you've gotten you money back.  how do we account for failed drugs i dont know but america is footing the research bill for the world with what we pay for everything.  until costs are brought into control federal subsidizing it is a F"n bandaid.

These issues are so damn complicated that if we attack them individually we simply end up with problems elsewhere and not really a solution to the overarching issue you mention later in the paragraph (control costs overall).  That's a lot of what AHCA is doing:  "we don't like the mandate"  "ok, nix the mandate"...and so on.  The bill taken as a whole is just going to blow up the system even though certain provisions may be ideologically pleasing (cut regulation!).

So to address the bolded part - ER's are ridiculously inefficient and unprofitable at dealing with health issues that should be treated in a primary care practice.   Sure, they may charge you $37 for a single pill of Ibuprofen and you'll be rightfully outraged.  But if you're in there for the flu because you're uninsured and don't have a PCP, then the hospital has nothing to bill you (or even Medicaid, if you're poor) to recoup even a tiny fraction of the administrative cost of processing you and the few minutes with an MD who may make $250K/year.

Any Obamacare replacement "plan" that pushes people out of insurance contracts (that allow them to engage a PCP) and back onto the street and into ERs is going to cost everyone a ton of money for substandard care.   Actually, it's possible that insurance companies will win at least in the short term.  They'll clean up the risk pools by pricing the sick out of them.

Anyway - regulating profit in the ER setting is a silly idea.  Hospitals don't make money on their ER's because so much of that care is for poor people.
« Last Edit: May 10, 2017, 02:50:23 PM by NESailor »

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2290 on: May 11, 2017, 05:26:36 AM »
So many responses from people on here who are being affected by the Republican efforts at dismantling the ACA, whether it's not being able to FIRE or not starting your own consultancy business or concern about losing health insurance in the marketplace once "high risk pools" are created.
I realize there are so many of us being harmed - and we're fortunate enough to have been saving money. For those who are financially dire and/or on Medicaid it's going to be far worse.

NESailor

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Re: What comes after the ACA?
« Reply #2291 on: May 11, 2017, 07:05:18 AM »
So many responses from people on here who are being affected by the Republican efforts at dismantling the ACA, whether it's not being able to FIRE or not starting your own consultancy business or concern about losing health insurance in the marketplace once "high risk pools" are created.
I realize there are so many of us being harmed - and we're fortunate enough to have been saving money. For those who are financially dire and/or on Medicaid it's going to be far worse.

Basically.  The individual bits and pieces of universal coverage are wildly popular across the political spectrum.  Unfortunately, huge chunks of the population have been conditioned to believe a bunch of nonsense about why a comprehensive solution is not possible in the US.  We have an inefficient and in many cases ineffective healthcare system and what keeps us from fixing the known and obvious issues is mostly ideological differences that are divorced from reality.  They also happen to be reinforced by powerful groups who benefit from the status quo. 

Tough nut to crack and I honestly feel bad about the folks who experience the bulk of the negative consequences of this mess - the working poor.  It may have to get a lot worse before those barriers are broken down.  Fortunately, the Republican leadership seems intent on doing just that.  Make things really bad really fast.

BeanCounter

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Re: What comes after the ACA?
« Reply #2292 on: May 11, 2017, 07:07:32 AM »
people that say that are really saying it would cost them $12 to 18k a year for insurance, when that is basically what they are already paying, they just don't realize it because it's not part of their cash compensation.

Yes, this phenomenon (i.e., individuals being unaware of just how large a component of their total compensation employer-sponsored health insurance actually represents) has already been observed in this very thread.  And BeanCounter's post appears to be a perfect illustration of that phenomenon.

However, the government's subsidization of employer-sponsored health insurance (via exempting that form of compensation from taxation)--which, as nereo explained in the linked post, is ultimately what gave rise to the phenomenon in the first place--means that, all else being equal, insurance coverage purchased independently on the open market will, on an after-tax basis, cost an individual more than the total cost (employer-paid + employee-paid premiums) of identical employer-sponsored coverage (assuming that the individual is subject to some positive amount of tax liability).
Actually I am acutely aware of the amount my employer is paying to cover my healthcare. Its as self insured plan and I'm one of the people responsible for running it . That's also how I know that purchasing our own family policy without the ACA would likely be cost prohibitive to us retiring early or becoming self employed. You can call that an "income" problem, but I don't see it that way. The problem is when the insurance company looks at my policy individually and not as part of a greater risk pool. And then has the ability to jack up my rates the moment I'm diagnosed with something or even worse cap their losses by imposing a lifetime cap. What I benefit from with my employer is being part of a much, much larger risk pool to smooth out the losses and the guarantee of insurance. You simply don't have that on the individual market pre-ACA.

nereo

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Re: What comes after the ACA?
« Reply #2293 on: May 11, 2017, 08:18:18 AM »
people that say that are really saying it would cost them $12 to 18k a year for insurance, when that is basically what they are already paying, they just don't realize it because it's not part of their cash compensation.

Yes, this phenomenon (i.e., individuals being unaware of just how large a component of their total compensation employer-sponsored health insurance actually represents) has already been observed in this very thread.  And BeanCounter's post appears to be a perfect illustration of that phenomenon.

However, the government's subsidization of employer-sponsored health insurance (via exempting that form of compensation from taxation)--which, as nereo explained in the linked post, is ultimately what gave rise to the phenomenon in the first place--means that, all else being equal, insurance coverage purchased independently on the open market will, on an after-tax basis, cost an individual more than the total cost (employer-paid + employee-paid premiums) of identical employer-sponsored coverage (assuming that the individual is subject to some positive amount of tax liability).
Actually I am acutely aware of the amount my employer is paying to cover my healthcare. Its as self insured plan and I'm one of the people responsible for running it . That's also how I know that purchasing our own family policy without the ACA would likely be cost prohibitive to us retiring early or becoming self employed. You can call that an "income" problem, but I don't see it that way. The problem is when the insurance company looks at my policy individually and not as part of a greater risk pool. And then has the ability to jack up my rates the moment I'm diagnosed with something or even worse cap their losses by imposing a lifetime cap. What I benefit from with my employer is being part of a much, much larger risk pool to smooth out the losses and the guarantee of insurance. You simply don't have that on the individual market pre-ACA.
You may be acutely aware of the costs, but a fundamental problem is that most Americans are not.  People covered by their employer's healthcare (the majority of Americans) have been so shielded from the real coast of their insurance that misperceptions run wild. One study showed only 4% of americans could correctly identify what a "deductible, co-pay, and out-of-pocket actually mean.
I had smart, educated friends who had their share of the premium increase from $67/mo to $100/mo, and they concluded that their total healthcare cost had increased by 50%. None believed that their actual premiums exceeded $12k/year.

As discussed, oh, 40 pages ago I think it's completely unjust that larger plans can negotiate for lower rates on medical coverage.  Sounds great if you are a member of that plan, but its awful if you're not part of a large plan.
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BeanCounter

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Re: What comes after the ACA?
« Reply #2294 on: May 11, 2017, 08:22:25 AM »
As discussed, oh, 40 pages ago I think it's completely unjust that larger plans can negotiate for lower rates on medical coverage.  Sounds great if you are a member of that plan, but its awful if you're not part of a large plan.
The more members a plan has the lower the rates because of the reduction in the overall risk pool. That's not unjust, that's just math. What is unjust is the every individual doesn't have the option to join a very large risk pool.

rantk81

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Re: What comes after the ACA?
« Reply #2295 on: May 11, 2017, 08:29:37 AM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

Assume that as a county we decided to implement universal health care by offering something similar/identical to the current Medicare program, but offering it to people of all ages, instead of just folks 65 years old. Assume that the cost of it would be funded by a payroll tax, similar to the FICA taxes. What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Even at 15%, wouldn't that be a palatable thing for the public at large, considering that employers would no longer be paying large sums of money to a group policy... and employees wouldn't be on the hook for payroll deductions for the group plans? 

I'd accept that, and I say that as someone who who earns a high income, and would be paying a significantly disproportionately higher amount than lower income folks.

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Re: What comes after the ACA?
« Reply #2296 on: May 11, 2017, 08:37:41 AM »
A local rep (not ours, who is even worse) sent an email crowing about the AHCA. In the Q&A section is this:

Can states raise costs for pre-existing conditions?
You won't be charged more as long as you maintain continuous coverage. If you live in a waiver state, have a pre-existing condition, and go without insurance for more than 63 days, only then can an insurer charge you higher premiums based on health status; however, this would only apply during the year following your lapse in coverage and the AHCA provides significant resources at the federal and state level for risk-sharing programs to help lower your premiums.


Is this correct? I was getting the idea that in a waiver state the insurance company could charge higher premiums based on health status even if you had not had a lapse in coverage.

nereo

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Re: What comes after the ACA?
« Reply #2297 on: May 11, 2017, 08:55:04 AM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

Assume that as a county we decided to implement universal health care by offering something similar/identical to the current Medicare program, but offering it to people of all ages, instead of just folks 65 years old. Assume that the cost of it would be funded by a payroll tax, similar to the FICA taxes. What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Well, the per-capita cost of healthcare in the US is just over $10k.  That's just over $3T/year.  The total current federal tax revue is ~$3.7T.  including state and local government (which also provide substantial amounts of health services thru state-employee coverage and public hospitals/clincs) there is ~$7T in total tax revenue.

There are several problems that urgently need addressing; The US pays more for its healthcare than any other developed nation (roughly 2x what UK, Germany, Canada, Ireland, etc. spend).  Also, because we've so hopelessly tied heath-insurance to employment (roughly 60%), and those companies get favorable tax treatment for doing so, disentangling the two would require a simultaneous revision of both the corporate tax code and health-care (including Medicaid, Medicare and the ACA).

IF we could reduce per-capita heath care spending to levels equal to other G-8 countries we'd - very broadly speaking - need to increase federal tax revenue by roughly 40%. Whether that comes from corporations (currently providing the lion's share of health insurance via tax breaks) or individuals is yet another can of worms. How state expenditures on health-care would alter taxes is another interesting and complex hypothetical, as the heavy burdens placed on many states like California would suddenly be lifted and placed on the federal level.
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desertadapted

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Re: What comes after the ACA?
« Reply #2298 on: May 11, 2017, 08:57:32 AM »
This has probably been covered elsewhere in the thread, but why does the right get away with framing the young/old cost ratio issue as a moral/fairness issue?  I have had employer-sponsored health care from one employer or another for the past ~20 years.  The young and the old, the sick and the well, all pay exactly the same amount towards their health care under employer plans.  But thereís much squawking about having to subsidize the old or the sick when it comes to the (relatively tiny) individual market.   What gives?  Why isnít whatís good for the goose, good for the gander?  Should we change employer plans to allow them to charge older and/or sicker employees more?  I'd love it the Dem's added THAT as an amendment to a senate bill to highlight the issue.  Why should folks with employer coverage be protected from age/health discrimination? 

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Re: What comes after the ACA?
« Reply #2299 on: May 11, 2017, 09:03:14 AM »
A local rep (not ours, who is even worse) sent an email crowing about the AHCA. In the Q&A section is this:

Can states raise costs for pre-existing conditions?
You won't be charged more as long as you maintain continuous coverage. If you live in a waiver state, have a pre-existing condition, and go without insurance for more than 63 days, only then can an insurer charge you higher premiums based on health status; however, this would only apply during the year following your lapse in coverage and the AHCA provides significant resources at the federal and state level for risk-sharing programs to help lower your premiums.


Is this correct? I was getting the idea that in a waiver state the insurance company could charge higher premiums based on health status even if you had not had a lapse in coverage.

Yes, this is correct, based on my reading of the AHCA bill (which I discussed in more detail in this post), except that I would not characterize the last condition in the italicized text as a requirement that "significant" risk-mitigation resources be dedicated (according to many health care policy experts, the minimum level of resources that need to be dedicated would be better described as "woefully inadequate").