Author Topic: What comes after the ACA?  (Read 655993 times)

wenchsenior

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Re: What comes after the ACA?
« Reply #4200 on: March 09, 2018, 10:10:42 AM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

This is not meaningful in terms of voter interest by either party.  The Dems never had more than a sliver's chance in hell of getting the Senate back this term, and most projections for the last few years have them losing seats.  Originally, projections were for them to pick up MORE seats in 2016 than they actually did, which they were planning to use as a buffer against their inevitable losses in 2018.  Oops.

Everything hinges on the Dems winning the House in 2018 because it has always been likely the GOP will have a bigger Senate majority after that. 
« Last Edit: March 09, 2018, 10:13:57 AM by wenchsenior »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4201 on: March 09, 2018, 10:31:38 AM »
That's what, $800 billion now?  Pretty easy money if we could only do something about the insurance & pharmaceutical lobbies' stranglehold on Congress.  The point is that our medical system is designed to flush money down the toilet, and it does so with sumptuous efficiency.

The point is that our economic system is designed to encourage spending, because that's what keeps the engine turning.  Congress doesn't care about universal or affordable health care NEARLY as much as they care about economic growth, and inefficient healthcare is perversely good for economic growth.

In the long run, of course, getting all of that waste out of healthcare would free up those dollars for more productive things like infrastructure or scholarships or actually funding government agencies like the IRS or the State Department so they can do their jobs, unlike the current arrangement.  Of course, it could also be used to give more tax cuts to the very wealthy, if you're a pro-inequality kind of person, but the point is the same; healthcare is inefficient and inefficiency should be bad for the economy.  In the short term, though, all of that healthcare waste pays salaries for millions of mid level workers, people who borrow money for cars and pay their mortgages and shop at target.  Cutting it out overnight would undoubtedly cause a recession, as the entire system had to re-equilibrate and all of those insurance processors and medical billing specialists were suddenly unemployed.

Yep, U.S. health care is one great big giant poster child for the broken window fallacy.
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Monkey Uncle

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Re: What comes after the ACA?
« Reply #4202 on: March 09, 2018, 10:37:08 AM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

This is not meaningful in terms of voter interest by either party.  The Dems never had more than a sliver's chance in hell of getting the Senate back this term, and most projections for the last few years have them losing seats.  Originally, projections were for them to pick up MORE seats in 2016 than they actually did, which they were planning to use as a buffer against their inevitable losses in 2018.  Oops.

Everything hinges on the Dems winning the House in 2018 because it has always been likely the GOP will have a bigger Senate majority after that.

Even within the context of a "blue wave" election, I could envision a nightmare scenario in which the Dems lose a few seats in the Senate and fail to capture a majority in the House.  Picking up seats in the House means nothing unless they actually take the majority, or at least get within a handful of seats of the majority such that Repubs in the few swing districts that are left feel some pressure not to totally plunge us into the oligarchic abyss.  Losing any seats at all in the Senate would hurt big time, because there aren't enough Susan Collinses and John McCains to keep the rest of them from going off the deep end.
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wenchsenior

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Re: What comes after the ACA?
« Reply #4203 on: March 09, 2018, 10:39:59 AM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

This is not meaningful in terms of voter interest by either party.  The Dems never had more than a sliver's chance in hell of getting the Senate back this term, and most projections for the last few years have them losing seats.  Originally, projections were for them to pick up MORE seats in 2016 than they actually did, which they were planning to use as a buffer against their inevitable losses in 2018.  Oops.

Everything hinges on the Dems winning the House in 2018 because it has always been likely the GOP will have a bigger Senate majority after that.

Even within the context of a "blue wave" election, I could envision a nightmare scenario in which the Dems lose a few seats in the Senate and fail to capture a majority in the House.  Picking up seats in the House means nothing unless they actually take the majority, or at least get within a handful of seats of the majority such that Repubs in the few swing districts that are left feel some pressure not to totally plunge us into the oligarchic abyss.  Losing any seats at all in the Senate would hurt big time, because there aren't enough Susan Collinses and John McCains to keep the rest of them from going off the deep end.

I agree.  Totally within the realm of possibility.

Jrr85

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Re: What comes after the ACA?
« Reply #4204 on: March 09, 2018, 11:36:58 AM »
The profits of the private insurers aren't the problem.  It's their overhead, and the overhead that they impose on physicians & hospitals.  Those two things together suck up the majority of private health care dollars.

Consider the hours physicians/nurses must spend on the phone getting preauthorizations and filling out paperwork when requested to justify a bill which happens very frequently.  There's also the typical 30% overhead for outsourced billing.  That means that when you pay a physician $100, $30 of that goes to the organization the physician pays for billing services.  The patchwork of different insurance companies & plans and the incredibly complex requirements they each have are so overwhelming that outsourcing is virtually a requirement.

In contrast, Medicare's overhead is in the single digits, and their billing procedure is much less complicated.  I know this is politically impossible, but if we changed nothing about our healthcare system except to move all privately insured people to Medicare and set their premiums to cover expenses, health care spending would instantly drop by around $600 billion.  Getting rid of many of the onerous and pointless requirements imposed by Obamacare (EHRs, "meaningful use", PQRI etc) would easily chop another $100 billion.
  Medicare's overhead is lower for a number of reasons not related to them being more efficient. 

And the excessive paperwork associated with private insurance is largely a result of us making the medical profession a private cartel and then expecting insurance companies to somehow stop medical professionals from collecting rents. 


Oh, and add another $100 billion in savings if Medicare were allowed to negotiate drug prices, and got them to the equivalent of what Canada pays.
  Maybe.  We already have a drug development problem.  I'd just like to see take a most favored nation approach with sales to any developed country.  Or maybe the average of the cost to OECD countries or even 125% of the weighted average price offered to OECD countries.
 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4205 on: March 09, 2018, 03:24:02 PM »
Democrat losses in the Senate can also spell disaster for Democrats' views for health care policy vis a vis Supreme Court nominations and future court decisions on the ACA/Obamacare.

tyort1

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Re: What comes after the ACA?
« Reply #4206 on: March 09, 2018, 03:33:21 PM »
That's what, $800 billion now?  Pretty easy money if we could only do something about the insurance & pharmaceutical lobbies' stranglehold on Congress.  The point is that our medical system is designed to flush money down the toilet, and it does so with sumptuous efficiency.

The point is that our economic system is designed to encourage spending, because that's what keeps the engine turning.  Congress doesn't care about universal or affordable health care NEARLY as much as they care about economic growth, and inefficient healthcare is perversely good for economic growth.

In the long run, of course, getting all of that waste out of healthcare would free up those dollars for more productive things like infrastructure or scholarships or actually funding government agencies like the IRS or the State Department so they can do their jobs, unlike the current arrangement.  Of course, it could also be used to give more tax cuts to the very wealthy, if you're a pro-inequality kind of person, but the point is the same; healthcare is inefficient and inefficiency should be bad for the economy.  In the short term, though, all of that healthcare waste pays salaries for millions of mid level workers, people who borrow money for cars and pay their mortgages and shop at target.  Cutting it out overnight would undoubtedly cause a recession, as the entire system had to re-equilibrate and all of those insurance processors and medical billing specialists were suddenly unemployed.

At least they would have health insurance!
Frugalite in training.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4207 on: April 04, 2018, 04:33:18 PM »
The Final Obamacare Tally Is In. About 400,000 Fewer People Signed Up This Year.

https://nyti.ms/2q2uV1G

"11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. The drop was relatively small, given that Mr. Trump had sharply cut federal outreach efforts and the open enrollment period was half as long as in past years.
Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the Affordable Care Act — popularly known as Obamacare — through their own marketplaces, enrollment remained the same as last year. "

iris lily

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Re: What comes after the ACA?
« Reply #4208 on: April 04, 2018, 04:52:56 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

Threshkin

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Re: What comes after the ACA?
« Reply #4209 on: April 04, 2018, 06:03:50 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.

iris lily

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Re: What comes after the ACA?
« Reply #4210 on: April 04, 2018, 06:42:30 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.

jim555

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Re: What comes after the ACA?
« Reply #4211 on: April 04, 2018, 06:50:16 PM »
The NY Essential Plan (NY's Basic Health Program plan) was targeted when DJT ended the CSR payments, shorting NY 1 billion dollars.  The scheme backfired and now the EP is overfunded due to the rise in Silver premiums causing more subsidy money to be spent than if they would have kept the CSR funding in place.  The rise in the benchmark caused the subsidy amounts to rise.  So DJT has improved the ACA!

Paul der Krake

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Re: What comes after the ACA?
« Reply #4212 on: April 04, 2018, 07:33:01 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.
If your income was low enough for these bargain premiums, why did you stay on COBRA at all?

Exflyboy

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Re: What comes after the ACA?
« Reply #4213 on: April 04, 2018, 08:58:54 PM »
The NY Essential Plan (NY's Basic Health Program plan) was targeted when DJT ended the CSR payments, shorting NY 1 billion dollars.  The scheme backfired and now the EP is overfunded due to the rise in Silver premiums causing more subsidy money to be spent than if they would have kept the CSR funding in place.  The rise in the benchmark caused the subsidy amounts to rise.  So DJT has improved the ACA!

Exactly.. our premium went from $36 to $15.10...:)

iris lily

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Re: What comes after the ACA?
« Reply #4214 on: April 04, 2018, 10:26:11 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.
If your income was low enough for these bargain premiums, why did you stay on COBRA at all?

I just wanted No Complications for the first year after retirement. I wanted to be free of concern about health care, health insurance and with cobra which we could easily afford, that policy was a known entity. Therevwas another complicating factor I wont go into here but COBRA coverage simplified that, too.

Simplicity is a luxury good.

Mr. Green

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Re: What comes after the ACA?
« Reply #4215 on: April 05, 2018, 02:26:43 PM »
The Final Obamacare Tally Is In. About 400,000 Fewer People Signed Up This Year.

https://nyti.ms/2q2uV1G

"11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. The drop was relatively small, given that Mr. Trump had sharply cut federal outreach efforts and the open enrollment period was half as long as in past years.
Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the Affordable Care Act — popularly known as Obamacare — through their own marketplaces, enrollment remained the same as last year. "
This is very impressive given the enrollment period for 2018 was cut in half and the budgets for the groups helping people enroll was cut by as much as 90%.
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Exflyboy

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Re: What comes after the ACA?
« Reply #4216 on: April 05, 2018, 03:47:21 PM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.

Mr. Green

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Re: What comes after the ACA?
« Reply #4217 on: April 05, 2018, 04:56:58 PM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.
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Exflyboy

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Re: What comes after the ACA?
« Reply #4218 on: April 05, 2018, 06:09:25 PM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Who knows how "the base" thinks... If indeed they do actually think.

Threshkin

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Re: What comes after the ACA?
« Reply #4219 on: April 05, 2018, 10:03:16 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.
If your income was low enough for these bargain premiums, why did you stay on COBRA at all?

If you drop COBRA before it expires you are not eligible for the subsidy.  I had to wait for COBRA to expire and then sign up for the ACA plan.

Exflyboy

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Re: What comes after the ACA?
« Reply #4220 on: April 05, 2018, 11:43:17 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.
If your income was low enough for these bargain premiums, why did you stay on COBRA at all?

If you drop COBRA before it expires you are not eligible for the subsidy.  I had to wait for COBRA to expire and then sign up for the ACA plan.

Huh?... We were offered COBRA, saw the price, said a four letter word and went straight to the ACA. Now of course if we had made a shit ton of money that year then we would not have got any subsidy on the ACA. But even without a subsidy the ACA was cheaper than COBRA.

Of course we made sure we managed our income such that we got a decent subsidy.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4221 on: April 06, 2018, 12:20:49 AM »
Huh?... We were offered COBRA, saw the price, said a four letter word and went straight to the ACA. Now of course if we had made a shit ton of money that year then we would not have got any subsidy on the ACA. But even without a subsidy the ACA was cheaper than COBRA.
Totally depends on the underlying cost of the employer plan, which is tied to the local market, health of employee pool, and benefits offered. If I left my job tomorrow and didn't qualify for subsidies, I'd stay on COBRA for as long as possible.

Exflyboy

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Re: What comes after the ACA?
« Reply #4222 on: April 06, 2018, 01:27:50 AM »
Huh?... We were offered COBRA, saw the price, said a four letter word and went straight to the ACA. Now of course if we had made a shit ton of money that year then we would not have got any subsidy on the ACA. But even without a subsidy the ACA was cheaper than COBRA.
Totally depends on the underlying cost of the employer plan, which is tied to the local market, health of employee pool, and benefits offered. If I left my job tomorrow and didn't qualify for subsidies, I'd stay on COBRA for as long as possible.

I see, so COBRA isn't always the bankrupt inducing stupid cost then?.. At least no more stupid than the rest of the unsubsidised HC system.

swampwiz

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Re: What comes after the ACA?
« Reply #4223 on: April 06, 2018, 02:35:33 AM »
If you drop COBRA before it expires you are not eligible for the subsidy.  I had to wait for COBRA to expire and then sign up for the ACA plan.

It is not so much that a COBRA subscriber cannot get the premium tax credit because he is eligible to get COBRA, but because quitting COBRA does not qualify the subscriber for application outside of the open enrollment period.  I would presume that a change in income, or residential move to another state, etc., could qualify.

https://obamacarefacts.com/questions/can-i-switch-from-cobra-to-obamacare/

swampwiz

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Re: What comes after the ACA?
« Reply #4224 on: April 06, 2018, 02:42:49 AM »
If your income was low enough for these bargain premiums, why did you stay on COBRA at all?

I just wanted No Complications for the first year after retirement. I wanted to be free of concern about health care, health insurance and with cobra which we could easily afford, that policy was a known entity. Therevwas another complicating factor I wont go into here but COBRA coverage simplified that, too.

Simplicity is a luxury good.
[/quote]

Something else to think about is that the deductible/out-of-pocket-max counter resets with a new policy.

swampwiz

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Re: What comes after the ACA?
« Reply #4225 on: April 06, 2018, 03:04:05 AM »
"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

There appears to be only 5 Democratic seats that are truly vulnerable: MO, IN, ND, MT, WV.  The first 2 were the result of the Republican candidate not being able to stop himself from saying that rape victims enjoy it.  However, the other 3 had legitimate popular victories, and of them, I only think WV is truly vulnerable.  But there are easily 3 or 4 Republican-held seats that look pretty good to switch: NV, AZ, TN (the latter because there is very popular Democratic ex-governor who will probably draw a Teat party whacko as an opponent), with McCain's current seat possibly being open.  I even give TX a chance due to the changing demographics. 

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4226 on: April 06, 2018, 05:17:25 AM »
Huh?... We were offered COBRA, saw the price, said a four letter word and went straight to the ACA. Now of course if we had made a shit ton of money that year then we would not have got any subsidy on the ACA. But even without a subsidy the ACA was cheaper than COBRA.
Totally depends on the underlying cost of the employer plan, which is tied to the local market, health of employee pool, and benefits offered. If I left my job tomorrow and didn't qualify for subsidies, I'd stay on COBRA for as long as possible.

I don't think that's right.  When I signed up for the ACA, healthcare.gov did not ask about the cost of the COBRA policy that was available to me.  I was not required to consider signing up for COBRA, regardless of the price.

However, if I had chosen to sign up for COBRA, voluntarily dropping it would not be considered a qualifying event.  You have to involuntarily lose your coverage for it to be considered a qualifying event.
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DreamFIRE

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Re: What comes after the ACA?
« Reply #4227 on: April 06, 2018, 05:26:58 AM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.
If your income was low enough for these bargain premiums, why did you stay on COBRA at all?

If you drop COBRA before it expires you are not eligible for the subsidy.  I had to wait for COBRA to expire and then sign up for the ACA plan.

You can drop COBRA and sign up for an ACA plan during the regular enrollment period, and you will be eligible for the same PCT and CSR whether or not you have had COBRA in the past.

jim555

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Re: What comes after the ACA?
« Reply #4228 on: April 06, 2018, 05:41:14 AM »
Some states have COBRA for 36 months.  If the ACA goes away then it might make sense to get a job long enough to qualify for COBRA and quit, then repeat.

Jrr85

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Re: What comes after the ACA?
« Reply #4229 on: April 06, 2018, 07:54:00 AM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.   

Paul der Krake

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Re: What comes after the ACA?
« Reply #4230 on: April 06, 2018, 08:45:23 AM »
Huh?... We were offered COBRA, saw the price, said a four letter word and went straight to the ACA. Now of course if we had made a shit ton of money that year then we would not have got any subsidy on the ACA. But even without a subsidy the ACA was cheaper than COBRA.
Totally depends on the underlying cost of the employer plan, which is tied to the local market, health of employee pool, and benefits offered. If I left my job tomorrow and didn't qualify for subsidies, I'd stay on COBRA for as long as possible.

I don't think that's right.  When I signed up for the ACA, healthcare.gov did not ask about the cost of the COBRA policy that was available to me.  I was not required to consider signing up for COBRA, regardless of the price.

However, if I had chosen to sign up for COBRA, voluntarily dropping it would not be considered a qualifying event.  You have to involuntarily lose your coverage for it to be considered a qualifying event.
You misunderstood me. I was only talking about COBRA attractiveness relative to ACA plans, not whether theoretical COBRA premiums determine ACA eligibility.

Basically I compared what I can get on the ACA with the amount of money paid by me and my employer (as reported on my W-2, box 12 code DD), and the plans are significantly worse. That won't be true for everyone.

protostache

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Re: What comes after the ACA?
« Reply #4231 on: April 06, 2018, 09:11:06 AM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.

Those are the expensive parts. Everything else is a rounding error when you're on the hook to cover expenses for anyone who walks in the door. They're also the parts that get less expensive when everyone participates, because the healthy people paying into the pool help take up the slack for the people with expensive conditions. If everyone participates, everyone pays less.

Mr. Green

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Re: What comes after the ACA?
« Reply #4232 on: April 06, 2018, 09:25:09 AM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.
I don't believe that creating poor coverage options as an alternative to the outrageous cost of healthcare in this country is an appropriate solution. It's great if we all want to continue paying $10 for a band-aid at the hospital but not so great and providing sensible healthcare for our citizenry. The ACA was one necessary step needed to set a standard of care for everyone. The next step should be fixing the cost. No one will ever want to address the real problem as long as we keep creating half measures that just cover it up.
RE in June 2016. Wife is joining me at the end of June!

Jrr85

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Re: What comes after the ACA?
« Reply #4233 on: April 06, 2018, 09:34:01 AM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.

Those are the expensive parts. Everything else is a rounding error when you're on the hook to cover expenses for anyone who walks in the door.
  The other coverage mandates are less expensive, but they are also almost entirely costs with no benefits.  You're taking what would already be an extremely large tax on anybody who is young or healthy and not low income that they might accept, and then adding on gratuitous costs.  Even if they are relatively small, you're pretty much guaranteed to be at the margin of acceptable costs just from guaranteed issue and no lifetime caps.   

They're also the parts that get less expensive when everyone participates, because the healthy people paying into the pool help take up the slack for the people with expensive conditions. If everyone participates, everyone pays less.

That's almost certainly wrong.  It's possible but unlikely that overall costs would go down by making it virtually free for people with low income (but still above medicaid cutoffs) to get healthcare.  But even if that were true (which woudl require that people use no or very little more healthcare even though it is suddenly available at a very cheap cost to them), you still have a lot of people paying a lot more to provide that coverage.  Basically you are sticking anybody who is young or healthy with a significant tax, unless they are low enough income to get subsidized. 

Young people were often foregoing insurance when they didn't have to pay extra to insurer older (and generally wealthier) people.  Of course they are not going to be thrilled to be forced to pay for their insurance and then an additional amount to subsidize wealthier older people.  Maybe they'll make their peace with it, just like social security taxes, and assume it's an ok tradeoff in order to be willing to take their turn screwing younger people.  But it's not surprising to me if in a lot of states, people aren't ok with that tradeoff. 

Jrr85

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Re: What comes after the ACA?
« Reply #4234 on: April 06, 2018, 09:42:17 AM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.
I don't believe that creating poor coverage options as an alternative to the outrageous cost of healthcare in this country is an appropriate solution. It's great if we all want to continue paying $10 for a band-aid at the hospital but not so great and providing sensible healthcare for our citizenry. The ACA was one necessary step needed to set a standard of care for everyone. The next step should be fixing the cost. No one will ever want to address the real problem as long as we keep creating half measures that just cover it up.

THe ACA was not a necessary step, except maybe politically if you really want to break healthcare because you think it will make nationalized healthcare or a relatively free market for health care politically viable. 

What we need to have reasonable healthcare costs, (such as a loosening of the stranglehold on supply; loosening regulation to allow innovative, lower cost treatments, even at the risk of a decrease in quality; lower third party payment; incentive alignment for preventative care and generally good health habits) are mostly politically unpopular. 

American voters want all the best care a relatively free health care market would provide, they want somebody else to pay for it, and they also want all the regulatory "protections" of a heavily regulated health care market.  Obamacare did a few good things, but for every good thing it did, it did as many bad things, basically because the politicians had to continue to give the american people the lies they demand and pretend that voters can actually have what they want. 


Mr. Green

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Re: What comes after the ACA?
« Reply #4235 on: April 06, 2018, 11:50:09 AM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.
I don't believe that creating poor coverage options as an alternative to the outrageous cost of healthcare in this country is an appropriate solution. It's great if we all want to continue paying $10 for a band-aid at the hospital but not so great and providing sensible healthcare for our citizenry. The ACA was one necessary step needed to set a standard of care for everyone. The next step should be fixing the cost. No one will ever want to address the real problem as long as we keep creating half measures that just cover it up.

THe ACA was not a necessary step, except maybe politically if you really want to break healthcare because you think it will make nationalized healthcare or a relatively free market for health care politically viable. 

What we need to have reasonable healthcare costs, (such as a loosening of the stranglehold on supply; loosening regulation to allow innovative, lower cost treatments, even at the risk of a decrease in quality; lower third party payment; incentive alignment for preventative care and generally good health habits) are mostly politically unpopular. 

American voters want all the best care a relatively free health care market would provide, they want somebody else to pay for it, and they also want all the regulatory "protections" of a heavily regulated health care market.  Obamacare did a few good things, but for every good thing it did, it did as many bad things, basically because the politicians had to continue to give the american people the lies they demand and pretend that voters can actually have what they want.
We'll have to agree to disagree. I don't consider the pre-ACA stance of "if you're more than a little bit sick you can fuck off and die (via refusal of coverage)" as an acceptable healthcare practice for a developed nation.
RE in June 2016. Wife is joining me at the end of June!

JayhawkRacer

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Re: What comes after the ACA?
« Reply #4236 on: April 06, 2018, 12:48:41 PM »
We'll have to agree to disagree. I don't consider the pre-ACA stance of "if you're more than a little bit sick you can fuck off and die (via refusal of coverage)" as an acceptable healthcare practice for a developed nation.

You clearly just hate capitalism. /s

Threshkin

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Re: What comes after the ACA?
« Reply #4237 on: April 06, 2018, 01:13:10 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

We were not eligible for the subsidy in 16 or 17 because of income.  Once you start COBRA you have to stay on it until the end or you cannot get the subsidy.

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.
If your income was low enough for these bargain premiums, why did you stay on COBRA at all?

If you drop COBRA before it expires you are not eligible for the subsidy.  I had to wait for COBRA to expire and then sign up for the ACA plan.

Huh?... We were offered COBRA, saw the price, said a four letter word and went straight to the ACA. Now of course if we had made a shit ton of money that year then we would not have got any subsidy on the ACA. But even without a subsidy the ACA was cheaper than COBRA.

Of course we made sure we managed our income such that we got a decent subsidy.

Jrr85

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Re: What comes after the ACA?
« Reply #4238 on: April 06, 2018, 01:51:40 PM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.
I don't believe that creating poor coverage options as an alternative to the outrageous cost of healthcare in this country is an appropriate solution. It's great if we all want to continue paying $10 for a band-aid at the hospital but not so great and providing sensible healthcare for our citizenry. The ACA was one necessary step needed to set a standard of care for everyone. The next step should be fixing the cost. No one will ever want to address the real problem as long as we keep creating half measures that just cover it up.

THe ACA was not a necessary step, except maybe politically if you really want to break healthcare because you think it will make nationalized healthcare or a relatively free market for health care politically viable. 

What we need to have reasonable healthcare costs, (such as a loosening of the stranglehold on supply; loosening regulation to allow innovative, lower cost treatments, even at the risk of a decrease in quality; lower third party payment; incentive alignment for preventative care and generally good health habits) are mostly politically unpopular. 

American voters want all the best care a relatively free health care market would provide, they want somebody else to pay for it, and they also want all the regulatory "protections" of a heavily regulated health care market.  Obamacare did a few good things, but for every good thing it did, it did as many bad things, basically because the politicians had to continue to give the american people the lies they demand and pretend that voters can actually have what they want.
We'll have to agree to disagree. I don't consider the pre-ACA stance of "if you're more than a little bit sick you can fuck off and die (via refusal of coverage)" as an acceptable healthcare practice for a developed nation.

Because that's exactly what happened.  It is nicer getting to work now that I don't have to dodge all the dead uninsured people littered about the road. 

Mr. Green

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Re: What comes after the ACA?
« Reply #4239 on: April 06, 2018, 02:31:33 PM »
I wonder when the goon squad will have another go at trashing the ACA? They do seem to be strangely quiet on the issue.

I hope they have forgotten about it personally.
The Feds shot down Iowa's attempt to flagrantly break the law regarding health insurance so that's a win. However the state is now trying to create a plan like the Tennessee Farm Beareu that is grandfathered into the ACA and it likely to be considered a legal option since it's not considered "health insurance." I can't say that I understand why the state wants to create plans that will likely harm their citizens long term by enrolling them in plans without the protections of the ACA's essential benefits.

Because they are not so dense to think that Obamacare only comes with benefits.
 Obamacare can be brutal for the non-subsidized, particularly in rural areas and it makes sense that states would try to find away to shield its residents from teh costs of some of the more ridiculous coverage mandates, even if some parts, such as guaranteed issue and no lifetime caps, would be seen as worth the cost by a majority of the residents.
I don't believe that creating poor coverage options as an alternative to the outrageous cost of healthcare in this country is an appropriate solution. It's great if we all want to continue paying $10 for a band-aid at the hospital but not so great and providing sensible healthcare for our citizenry. The ACA was one necessary step needed to set a standard of care for everyone. The next step should be fixing the cost. No one will ever want to address the real problem as long as we keep creating half measures that just cover it up.

THe ACA was not a necessary step, except maybe politically if you really want to break healthcare because you think it will make nationalized healthcare or a relatively free market for health care politically viable. 

What we need to have reasonable healthcare costs, (such as a loosening of the stranglehold on supply; loosening regulation to allow innovative, lower cost treatments, even at the risk of a decrease in quality; lower third party payment; incentive alignment for preventative care and generally good health habits) are mostly politically unpopular. 

American voters want all the best care a relatively free health care market would provide, they want somebody else to pay for it, and they also want all the regulatory "protections" of a heavily regulated health care market.  Obamacare did a few good things, but for every good thing it did, it did as many bad things, basically because the politicians had to continue to give the american people the lies they demand and pretend that voters can actually have what they want.
We'll have to agree to disagree. I don't consider the pre-ACA stance of "if you're more than a little bit sick you can fuck off and die (via refusal of coverage)" as an acceptable healthcare practice for a developed nation.

Because that's exactly what happened.  It is nicer getting to work now that I don't have to dodge all the dead uninsured people littered about the road.
It's easy to be non-chalant about it until you're the one who gets cancer at 40 and your insurance decides you're not profitable anymore and your spouse's biggest worry becomes figuring out how to stay employed so you can have insurance while balancing kids and a sick adult at home. That's just one of many examples. If I was an insurance company with no conscience, a bottom line to care about, and no law that says I had to keep insuring you then I'd drop you too.
RE in June 2016. Wife is joining me at the end of June!

bacchi

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Re: What comes after the ACA?
« Reply #4240 on: April 06, 2018, 02:46:41 PM »

Because that's exactly what happened.  It is nicer getting to work now that I don't have to dodge all the dead uninsured people littered about the road.
It's easy to be non-chalant about it until you're the one who gets cancer at 40 and your insurance decides you're not profitable anymore and your spouse's biggest worry becomes figuring out how to stay employed so you can have insurance while balancing kids and a sick adult at home. That's just one of many examples. If I was an insurance company with no conscience, a bottom line to care about, and no law that says I had to keep insuring you then I'd drop you too.

Or worse, if you didn't have employer coverage.

http://articles.latimes.com/2010/apr/28/business/la-fi-0428-insure-rescission-20100428

Quote
The practice [rescission] resulted in some people losing coverage through no fault of their own, often over trivial bits of health history that had nothing to do with the claims that triggered the investigations.

Quote
The lawyer won a $9-million judgment against Health Net in 2008 over its rescission of hairdresser Patsy Bates after she was diagnosed with breast cancer. Evidence showed the company paid bonuses to an employee based in part on rescission volume.
(emphasis added)

Thank you, Obama!

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4241 on: April 06, 2018, 04:31:59 PM »
It's easy to be non-chalant about it until you're the one who gets cancer at 40 and your insurance decides you're not profitable anymore and your spouse's biggest worry becomes figuring out how to stay employed so you can have insurance while balancing kids and a sick adult at home. That's just one of many examples. If I was an insurance company with no conscience, a bottom line to care about, and no law that says I had to keep insuring you then I'd drop you too.

*Raises hand*

Except I'm the spouse, and it was 31, not 40.

I still worry about staying employed for insurance, especially now.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4242 on: April 06, 2018, 05:29:29 PM »
Thank you everyone for the intelligent responses and not allowing ourselves to have selective amnesia about the way insurance companies doled out health insurance when they went unregulated.

mm1970

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Re: What comes after the ACA?
« Reply #4243 on: April 06, 2018, 05:37:00 PM »
It's easy to be non-chalant about it until you're the one who gets cancer at 40 and your insurance decides you're not profitable anymore and your spouse's biggest worry becomes figuring out how to stay employed so you can have insurance while balancing kids and a sick adult at home. That's just one of many examples. If I was an insurance company with no conscience, a bottom line to care about, and no law that says I had to keep insuring you then I'd drop you too.

*Raises hand*

Except I'm the spouse, and it was 31, not 40.

I still worry about staying employed for insurance, especially now.
Yep.  I know many folks who were:
1.  Unable to get insurance due to pre-existing conditions - that were covered by the same insurer in a different state.  Move states, no insurance!
2.  Were unemployed for months and unable to pay for cobra
3.  Were diagnosed with cancer.  What if they lost their job?  After working 30 years? I guess, fuck off and die?
4.  My cousin died from a leg infection.  A fucking leg infection.
5.  My friend's brother died because he didn't have insurance and couldn't pay for medical care.

Just because you don't know anyone personally doesn't mean it doesn't happen.

obstinate

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Re: What comes after the ACA?
« Reply #4244 on: April 07, 2018, 04:25:02 PM »
Thank you everyone for the intelligent responses and not allowing ourselves to have selective amnesia about the way insurance companies doled out health insurance when they went unregulated.
I wouldn't necessarily blame the insurance companies. Under the laws we had then, any other course of action would quickly have run a company bankrupt because of all the adverse incentives in the market for healthcare. But it's important to recognize that this is not a problem that can be solved in a totally free market. That's why we need things like the ACA, to establish an environment in which an insurance company can provide effective insurance without going bankrupt.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4245 on: April 07, 2018, 09:39:23 PM »
Thank you everyone for the intelligent responses and not allowing ourselves to have selective amnesia about the way insurance companies doled out health insurance when they went unregulated.
I wouldn't necessarily blame the insurance companies. Under the laws we had then, any other course of action would quickly have run a company bankrupt because of all the adverse incentives in the market for healthcare. But it's important to recognize that this is not a problem that can be solved in a totally free market. That's why we need things like the ACA, to establish an environment in which an insurance company can provide effective insurance without going bankrupt.

Yes totally agree.

Gin1984

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Re: What comes after the ACA?
« Reply #4246 on: April 08, 2018, 12:20:41 PM »
Some states have COBRA for 36 months.  If the ACA goes away then it might make sense to get a job long enough to qualify for COBRA and quit, then repeat.
What states other than California?

Gin1984

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Re: What comes after the ACA?
« Reply #4247 on: April 08, 2018, 12:24:28 PM »
It's easy to be non-chalant about it until you're the one who gets cancer at 40 and your insurance decides you're not profitable anymore and your spouse's biggest worry becomes figuring out how to stay employed so you can have insurance while balancing kids and a sick adult at home. That's just one of many examples. If I was an insurance company with no conscience, a bottom line to care about, and no law that says I had to keep insuring you then I'd drop you too.

*Raises hand*

Except I'm the spouse, and it was 31, not 40.

I still worry about staying employed for insurance, especially now.
Mine was not cancer, I just locked up a muscle and then could not get ANY non-employer insurance for ANY sum of money even if it was a high deductible or excluded that issue.  I tried for over six months.

jim555

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Re: What comes after the ACA?
« Reply #4248 on: April 08, 2018, 06:04:33 PM »
Some states have COBRA for 36 months.  If the ACA goes away then it might make sense to get a job long enough to qualify for COBRA and quit, then repeat.
What states other than California?
NY, may be others too.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4249 on: April 08, 2018, 06:45:16 PM »
I was reading back over some previous pages and a couple comments that I didn't see followed up on that I wanted to address better late than never:

Don't forget that if you can keep your AGI between 138%-400% of the federal poverty limit you get subsidies.

ACA actually uses a MAGI calculation, which will differ for many people at some point compared to AGI.

For a couple with three kids (like my family), 400% of the FPL is $98,400 in 2017.  If you can't keep your paper income below that as a retired mustachian, I think you're doing something wrong. 

Remember that when you sell stock from a taxable account only the gains are income, not the principal you've contributed. 
Remember that your Roth IRA contributions can come back out at any time for any reason, penalty free and tax free.
Remember that only a portion of your SS benefits count as taxable income.

Don't remember that third point in this context.  For purposes of MAGI and ACA, both taxable and non-taxable SS benefits are included for determining your eligibility for PTC & CSR.  This difference is significant enough for me that I have changed my long term road map to delay taking SS benefits until at least age 65 in order to keep my MAGI lower, assuming current ACA rules are still in place then.

https://www.healthcare.gov/income-and-household-information/income/