Author Topic: What comes after the ACA?  (Read 655390 times)

DreamFIRE

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Re: What comes after the ACA?
« Reply #4300 on: April 19, 2018, 09:07:57 PM »
I'm only paying about $60/mo for my healthcare premiums here in the U.S. and have a $100 deductible.

I think that works OK on Medicaid (maybe) but remember if you are on an ACA plan or an employer plan and you have to go to the ER out of network you will be balanced billed and could still see a bill in the $100k's + after a stint in the ICU.

So even though premiums might be low for you there are still huge structural problems with the US HC system that don't exist in other countries.. It depends on what benefits you would qualify for too of course.

Mine is an employer plan.  I wasn't sure on the out of network, but I didn't think it was that extreme with my plan.  So I just looked it up.  Our out of network emergency services (including ambulance) says $100 co-pay.  Hospital services out of network are covered at 50%.  But the maximum yearly out of pocket for out of network says $10,000.  So, that's pretty high, but at least it's not $100K.  As far as the ACA plans, I haven't investigated it that deeply since that's a year+ out for me.  I have some relatives on it - no horror stories yet.

Exflyboy

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Re: What comes after the ACA?
« Reply #4301 on: April 19, 2018, 09:26:18 PM »
I think you'll find that ACA out of network is close to zero to none! What they do say is that OON is covered for emergencies.

But what that means is the insurance company will pay the same as what it does to in network providers.. The problem is the hospital and all its sub contractors will balance bill the patient for the rest of their BS bill.

So yes a road accident plus a few days in the ICU could easily be $100k OOP.

Are you sure your employer plan doesn't work the same way??

DreamFIRE

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Re: What comes after the ACA?
« Reply #4302 on: April 19, 2018, 09:44:13 PM »
I think you'll find that ACA out of network is close to zero to none! What they do say is that OON is covered for emergencies.

But what that means is the insurance company will pay the same as what it does to in network providers.. The problem is the hospital and all its sub contractors will balance bill the patient for the rest of their BS bill.

So yes a road accident plus a few days in the ICU could easily be $100k OOP.

Are you sure your employer plan doesn't work the same way??
Yes, our plan has in network and out of network benefits.  The numbers I gave above were for out of network.   Maximum out of pocket is $10,000 for out of network.   It was much lower for in network.
« Last Edit: April 19, 2018, 09:46:26 PM by DreamFIRE »

maizeman

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Re: What comes after the ACA?
« Reply #4303 on: April 19, 2018, 09:47:01 PM »
Yup. The OOP max is the maximum your insurance company is going to charge you. In states that allow balance billing that doesn't protect you from an out of network provider coming after you for all the money they think your insurance company should have paid, but didn't.

Google "balance billing".

DreamFIRE

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Re: What comes after the ACA?
« Reply #4304 on: April 19, 2018, 10:07:58 PM »
We have a separate out of pocket maximum which is based on the fact that an out of network provider will cost the insurance company more.   That's also why they only cover 50% of the hospital bill, not 100% like in network.   But at $10,000, my insurer will pay 100%, so the provider won't bill me directly for higher costs as the insurance company will pay for anything above that.  That's how our plan works.  I've worked with hundreds of people on the same plan for over 17 years, and I haven't heard of a single complaint.

There are also laws/regulations in my state addressing balance billing.

Psychstache

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Re: What comes after the ACA?
« Reply #4305 on: April 24, 2018, 10:07:18 AM »
We have a separate out of pocket maximum which is based on the fact that an out of network provider will cost the insurance company more.   That's also why they only cover 50% of the hospital bill, not 100% like in network.   But at $10,000, my insurer will pay 100%, so the provider won't bill me directly for higher costs as the insurance company will pay for anything above that.  That's how our plan works.  I've worked with hundreds of people on the same plan for over 17 years, and I haven't heard of a single complaint.

There are also laws/regulations in my state addressing balance billing.

That is the part that makes all of the difference. If you are in a state with basically no regs on balance billing, it is a crapshoot. Our state dept of insurance offers a mediation process, but that is a plan on hope. Also given the literature on their website, they seem a little...out of touch with current realities:

"Balance billing Ė or a surprise medical bill Ė happens when you get a bill from a doctor, hospital, or other health care provider who isnít part of your health planís network. Often, consumers didnít know they were getting care from out-of-network providers.

For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network doctor. The doctor and the hospital each bill $1,000 for their services, and the health plan pays them each $400. The in-network hospital can only bill the patient for copays, deductibles, and coinsurance amounts. The doctor, however, may bill for the $600 that the health plan didnít pay, as well as any copays, deductibles, and coinsurance."

bold mine.

Out of network emergency doc with a $1000 bill? Yeah, I think they missed a zero.

Exflyboy

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Re: What comes after the ACA?
« Reply #4306 on: April 24, 2018, 10:59:34 AM »
Here in Oregon they have a halfway measure they just passed this year.

If you go to an in-network hospital then an OON provider from within that hospital can't balance bill.

If you go to an OON hospital, even for emergency care they can (and will) balance bill.

Knowing this of course the insurance company have severely restricted the area to about 5 miles from my front door for anything to ne in network.

So travelling on one of these plans leaves you wide open to a big fat bill. I don't think we will be taking any driving across the USA type vacation with this level of HC.

MDM

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Re: What comes after the ACA?
« Reply #4307 on: April 24, 2018, 11:49:04 AM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4308 on: April 24, 2018, 01:47:59 PM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?

Does this calculation take into account that circular issue that if you get a subsidy it lowers health insurance expense, which raises AGI, which then lowers the subsidy, which then in turn raises the AGI ?

MDM

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Re: What comes after the ACA?
« Reply #4309 on: April 24, 2018, 01:56:44 PM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?

Does this calculation take into account that circular issue that if you get a subsidy it lowers health insurance expense, which raises AGI, which then lowers the subsidy, which then in turn raises the AGI ?
Not yet.  That's only for self-employment income and associated health insurance deduction on Form 1040 line 29.  For W-2, pension, SS benefits, etc., health costs might be itemized deductions but that would not affect AGI.

The iterative calculations for the self-employment situation might be worth doing in a later version, but one step at at time....

MDM

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Re: What comes after the ACA?
« Reply #4310 on: April 24, 2018, 04:19:02 PM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?
Online now.  See this post.  Suggestions welcomed.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4311 on: April 24, 2018, 09:28:07 PM »
We have a separate out of pocket maximum which is based on the fact that an out of network provider will cost the insurance company more.   That's also why they only cover 50% of the hospital bill, not 100% like in network.   But at $10,000, my insurer will pay 100%, so the provider won't bill me directly for higher costs as the insurance company will pay for anything above that.  That's how our plan works.  I've worked with hundreds of people on the same plan for over 17 years, and I haven't heard of a single complaint.

There are also laws/regulations in my state addressing balance billing.

That is the part that makes all of the difference. If you are in a state with basically no regs on balance billing, it is a crapshoot. Our state dept of insurance offers a mediation process, but that is a plan on hope. Also given the literature on their website, they seem a little...out of touch with current realities:

"Balance billing Ė or a surprise medical bill Ė happens when you get a bill from a doctor, hospital, or other health care provider who isnít part of your health planís network. Often, consumers didnít know they were getting care from out-of-network providers.

For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network doctor. The doctor and the hospital each bill $1,000 for their services, and the health plan pays them each $400. The in-network hospital can only bill the patient for copays, deductibles, and coinsurance amounts. The doctor, however, may bill for the $600 that the health plan didnít pay, as well as any copays, deductibles, and coinsurance."

I'm fortunate to also have an out of network maximum out of pocket, which is the maximum the insurance company will stick me with for out of network healthcare costs.  Our out of network and in network for emergency care is the same $100 co-pay.  It sounds like many of the ACA plans don't have very good out of network coverage/caps.

I'm also in one of the few states with better balance billing protections laws, as shown in green in this graphic:



Monkey Uncle

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Re: What comes after the ACA?
« Reply #4312 on: April 25, 2018, 05:04:01 AM »
We have a separate out of pocket maximum which is based on the fact that an out of network provider will cost the insurance company more.   That's also why they only cover 50% of the hospital bill, not 100% like in network.   But at $10,000, my insurer will pay 100%, so the provider won't bill me directly for higher costs as the insurance company will pay for anything above that.  That's how our plan works.  I've worked with hundreds of people on the same plan for over 17 years, and I haven't heard of a single complaint.

There are also laws/regulations in my state addressing balance billing.

That is the part that makes all of the difference. If you are in a state with basically no regs on balance billing, it is a crapshoot. Our state dept of insurance offers a mediation process, but that is a plan on hope. Also given the literature on their website, they seem a little...out of touch with current realities:

"Balance billing Ė or a surprise medical bill Ė happens when you get a bill from a doctor, hospital, or other health care provider who isnít part of your health planís network. Often, consumers didnít know they were getting care from out-of-network providers.

For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network doctor. The doctor and the hospital each bill $1,000 for their services, and the health plan pays them each $400. The in-network hospital can only bill the patient for copays, deductibles, and coinsurance amounts. The doctor, however, may bill for the $600 that the health plan didnít pay, as well as any copays, deductibles, and coinsurance."

I'm fortunate to also have an out of network maximum out of pocket, which is the maximum the insurance company will stick me with for out of network healthcare costs.  Our out of network and in network for emergency care is the same $100 co-pay.  It sounds like many of the ACA plans don't have very good out of network coverage/caps.

I'm also in one of the few states with better balance billing protections laws, as shown in green in this graphic:



Regarding the bolded paragraph above: the important point in all of this is that your insurance policy is not protecting you from balance billing.  The insurance company does not have the power to compel the out-of-network provider to accept their payment without balance billing the patient, nor does the provider have the power to force the insurance company to pay the full amount of whatever ridiculous list price they dream up.  If you are truly protected from balance billing, it is only because your state has outlawed the practice; they are just telling the provider to go suck it.  Basically the state has handed all of the negotiating power over to the insurance company to pay the provider whatever they want to pay them, and the provider has no recourse for recovering the remainder of the bill.

I live in a state that has not outlawed balance billing, and my insurance policy also has an out-of-network OOP maximum and a provision stipulating that all emergency care will be reimbursed as if it were in-network.  But the insurance company is not going to pay whatever the provider bills.  They are going to pay them what they would have paid an in-network provider, and it is up to the provider to decide whether they want to pursue the patient for the rest of the bill.
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DreamFIRE

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Re: What comes after the ACA?
« Reply #4313 on: April 25, 2018, 05:29:44 AM »
I live in a state that has not outlawed balance billing, and my insurance policy also has an out-of-network OOP maximum and a provision stipulating that all emergency care will be reimbursed as if it were in-network.  But the insurance company is not going to pay whatever the provider bills.  They are going to pay them what they would have paid an in-network provider, and it is up to the provider to decide whether they want to pursue the patient for the rest of the bill.

It sounds like you have some crap insurance if they're not paying what it states right on your policy.  One of the nice things about where I work is that we have good health insurance with very low deductibles.  I haven't heard of a single problem with either of my last couple jobs going back 30 years and hundreds of employees.

Exflyboy

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Re: What comes after the ACA?
« Reply #4314 on: April 25, 2018, 09:31:05 AM »
I live in a state that has not outlawed balance billing, and my insurance policy also has an out-of-network OOP maximum and a provision stipulating that all emergency care will be reimbursed as if it were in-network.  But the insurance company is not going to pay whatever the provider bills.  They are going to pay them what they would have paid an in-network provider, and it is up to the provider to decide whether they want to pursue the patient for the rest of the bill.

It sounds like you have some crap insurance if they're not paying what it states right on your policy.  One of the nice things about where I work is that we have good health insurance with very low deductibles.  I haven't heard of a single problem with either of my last couple jobs going back 30 years and hundreds of employees.

This is not "crap" insurance*. This what the industry standard is these days.. What you have is especially "good" insurance.

They do pay what is stated on the policy.. But they don't make it clear. What is stated in a roundabout way is they will pay an OON provider in the same amount as IN network for emergencies and you wont have to pay your INSURANCE COMPANY any more than your OOP max.

What they don't tell you is WHAT they will pay is likely far lower then your OON provider(s) will charge you and the provider will come directly to the patient for the rest.

 In other words the OOP portion is almost meaningless when it comes to OON providers.


* Crap vs good are relative terms of course.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4315 on: April 25, 2018, 05:08:08 PM »
I live in a state that has not outlawed balance billing, and my insurance policy also has an out-of-network OOP maximum and a provision stipulating that all emergency care will be reimbursed as if it were in-network.  But the insurance company is not going to pay whatever the provider bills.  They are going to pay them what they would have paid an in-network provider, and it is up to the provider to decide whether they want to pursue the patient for the rest of the bill.

It sounds like you have some crap insurance if they're not paying what it states right on your policy.  One of the nice things about where I work is that we have good health insurance with very low deductibles.  I haven't heard of a single problem with either of my last couple jobs going back 30 years and hundreds of employees.

This is not "crap" insurance*. This what the industry standard is these days.. What you have is especially "good" insurance.

They do pay what is stated on the policy.. But they don't make it clear. What is stated in a roundabout way is they will pay an OON provider in the same amount as IN network for emergencies and you wont have to pay your INSURANCE COMPANY any more than your OOP max.

What they don't tell you is WHAT they will pay is likely far lower then your OON provider(s) will charge you and the provider will come directly to the patient for the rest.

 In other words the OOP portion is almost meaningless when it comes to OON providers.

Yes, that sounds like crap, even if it's standard.  I believe I saw in one of these threads discussing ACA about policies that didn't mention out of network at all or only in reference to "emergency" care.

I was going to see what my policy states in more detail, but I only found the provider reference that says when using an out of network provider to contact the insurance provider within 48 hours or as soon as possible.

The map I posted above is from an article posted Oct 2017, so it might not be up to date.
https://www.insidearm.com/news/00043325-most-states-still-dont-have-comprehensive/

This is something I'll have to consider when I FIRE since re-locating is a possibility for me, and it looks like most states don't have the same protections in place as I have now.  Since I'm more likely to be traveling around during FIRE, it makes it an even bigger issue at that point.

Exflyboy

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Re: What comes after the ACA?
« Reply #4316 on: April 25, 2018, 05:49:12 PM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

Mr. Green

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Re: What comes after the ACA?
« Reply #4317 on: April 26, 2018, 07:28:02 AM »
After reading the recent Ballance billing posts here I looked up the law for Maryland and North Carolina and both states prohibit balance billing for HMOs. I found it interesting that only applied to HMOs.
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Exflyboy

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Re: What comes after the ACA?
« Reply #4318 on: April 26, 2018, 10:01:03 AM »
So does that mean you can go to an OON hospital and have a max OOP if you are on an HMO?

Or does that just prevent balance billing from within network hospitals?

radram

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Re: What comes after the ACA?
« Reply #4319 on: April 26, 2018, 10:18:56 AM »
Does the law that prevents balance billing cover the address of the hospital, or the address of the customer, or both?

My state does not prevent balance billing. California does. If I travel to California and have emergency services, can the hospital balance bill me in my state?

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4320 on: April 26, 2018, 11:03:45 AM »
Does the law that prevents balance billing cover the address of the hospital, or the address of the customer, or both?

My state does not prevent balance billing. California does. If I travel to California and have emergency services, can the hospital balance bill me in my state?

It applies to the location where the bill was incurred.
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DreamFIRE

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Re: What comes after the ACA?
« Reply #4321 on: April 26, 2018, 05:14:16 PM »
Does the law that prevents balance billing cover the address of the hospital, or the address of the customer, or both?

My state does not prevent balance billing. California does. If I travel to California and have emergency services, can the hospital balance bill me in my state?

From this info I found, it looks like the balance billing protections are relevant to the state where the employee is insured:

Of course, emergencies donít always happen close to home. One way to research your planís coverage for care rendered out-of-state is to ask your insurance company for a copy of your certificate of coverage, which outlines specific provisions that may apply in that scenario, said Chuck Bell, programs director at Consumers Union, the policy and advocacy arm of Consumer Reports.

If a patient gets a surprise bill from care provided at an out-of-state facility, jurisdiction will depend on the patientís health plan, Bell said. If sheís in whatís known as a fully insured small-group, large group or individual plan, then the laws that apply in that situation should be the laws of the state where sheís insured. So, for example, if a consumer covered in New York state gets billed in a state without a balance billing law, New York protections should prevail, Bell said.


Reference:
https://www.marketwatch.com/story/how-to-handle-surprise-medical-bills-2015-12-21

radram

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Re: What comes after the ACA?
« Reply #4322 on: April 26, 2018, 11:08:37 PM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

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Re: What comes after the ACA?
« Reply #4323 on: April 27, 2018, 05:11:41 AM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

I should probably stay quiet since I have not researched this question, but I can't imagine that a hospital in Montana is going to submit to a New York law that says they can't recover a debt from a patient.
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DreamFIRE

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Re: What comes after the ACA?
« Reply #4324 on: April 27, 2018, 05:24:06 AM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

If not an employee, that would still be the person insured.

My response is a direct quote from the website linked to in my previous post.  That's what I would have expected to be the case based on the wording of some of the balance billing protections I have read about.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4325 on: April 27, 2018, 12:14:57 PM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

I should probably stay quiet since I have not researched this question, but I can't imagine that a hospital in Montana is going to submit to a New York law that says they can't recover a debt from a patient.

This^

State 1 has no jurisdiction in State 2. Absent a federal law on the matter, I just don't see how you could get a hospital in State 2 to abide by State 1 law. Payors could absolutely solve this problem by forcing the provider to accept their payment as payment-in-full or GTFO.

Honestly, this is the perfect scenario to apply the Commerce Clause, because it's absolutely an interstate issue.

FWIW, I don't particularly trust Marketwatch as a source for strong healthcare reporting.
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Re: What comes after the ACA?
« Reply #4326 on: May 07, 2018, 09:47:52 PM »
What comes after the ACA?

Cuts to CHIP.

DarkandStormy

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Re: What comes after the ACA?
« Reply #4327 on: May 08, 2018, 08:25:54 AM »
What comes after the ACA?

Cuts to CHIP.

What kind of evil wants to take money out of a program that gives kids from poor families health coverage?

Meanwhile, in Michigan they're proposing to spend MORE money to take away Medicaid from citizens.

https://www.cbpp.org/blog/michigans-medicaid-proposal-would-harm-low-income-workers-and-cant-be-fixed
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DarkandStormy

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Re: What comes after the ACA?
« Reply #4328 on: May 08, 2018, 08:29:26 AM »
I apologize if this has been posted (long thread, ya'll).  Here is a podcast on how to expand the ACA and get to universal coverage.

https://crooked.com/podcast/can-we-have-medicare-for-all/

Adam Gaffney is advocating a Medicare for All proposal in 2020 (hopefully).

Andy Slavitt started up United States of Care earlier this year - https://unitedstatesofcare.org/our-mission/

I think Slavitt is advocating for smaller incremental changes in 2020.
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Paul der Krake

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Re: What comes after the ACA?
« Reply #4329 on: May 08, 2018, 07:31:03 PM »
To be fair, CHIP isn't exactly for the poor. Eligibility varies by state, but it's universally much higher than Medicaid eligibility, and copays are very low. Maybe there is some fat to be cut. I don't really understand the administration's argument that the cuts won't affect the operations of the program though. What exactly are they cutting?

bacchi

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Re: What comes after the ACA?
« Reply #4330 on: May 08, 2018, 08:46:23 PM »
What comes after the ACA?

Cuts to CHIP.

What kind of evil wants to take money out of a program that gives kids from poor families health coverage?

The "Fuck you; I've got mine" crowd.

Quote
Meanwhile, in Michigan they're proposing to spend MORE money to take away Medicaid from citizens.

https://www.cbpp.org/blog/michigans-medicaid-proposal-would-harm-low-income-workers-and-cant-be-fixed

Interestingly, Idaho has a good chance of expanding Medicaid this November.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4331 on: May 08, 2018, 08:51:37 PM »
And Paul Krugman's take:
"a number of Republican-controlled states are trying to make Medicaid harder to get, notably by imposing work requirements on recipients.
What is the point of these work requirements? The ostensible justification ó cracking down on able-bodied Medicaid recipients who should be working but arenít ó is nonsense: There are very few people meeting that description. The real goal is simply to make getting health care harder, by imposing onerous reporting and paperwork requirements and punishing people who lose their jobs for reasons beyond their control."

"Gnawing Away at Health Care"
https://nyti.ms/2KHDqsw

Paul der Krake

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Re: What comes after the ACA?
« Reply #4332 on: May 08, 2018, 11:09:33 PM »
There is a belief among the ideological wing of the party that numbers around benefits recipients are BS because it's in the recipients' interest to paint the most favorable picture possible. They point to towns in Appalachia with 10-20% of residents on SS(D)I. If you listen to the Kentucky governor defend his work requirements, it all sounds pretty reasonable: low hours, or job training, or demonstrable illness.

And that message works wonders on people who struggle to afford their premiums.


jim555

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Re: What comes after the ACA?
« Reply #4333 on: May 09, 2018, 06:02:50 AM »
They couldn't change the law so now they are trying to change the law through 1115 waivers to impose work requirements.  The problem is it is not legal, lawsuits have already begun.

talltexan

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Re: What comes after the ACA?
« Reply #4334 on: May 11, 2018, 12:11:47 PM »
There's excitement around universal health care, but will it be a winning issue for Democrats? I cannot help but feel like saying they'll put in single-payer is a great way to help Trump win a second term in the White House.

DarkandStormy

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Re: What comes after the ACA?
« Reply #4335 on: May 11, 2018, 12:25:08 PM »
There's excitement around universal health care, but will it be a winning issue for Democrats? I cannot help but feel like saying they'll put in single-payer is a great way to help Trump win a second term in the White House.

http://thehill.com/policy/healthcare/351928-poll-majority-supports-single-payer-healthcare

Quote
The latest Harvard-Harris Poll survey found 52 percent favor a single-payer system against 48 who oppose it. A strong majority of Democrats ó 69 percent ó back the idea. Republicans oppose single-payer, 65-35, and independents are split, with 51 percent opposing and 49 supporting.
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talltexan

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Re: What comes after the ACA?
« Reply #4336 on: May 14, 2018, 07:02:57 AM »
Indeed I'll accept the article; but Trump would campaign on promising that no one will lose their health care--just like he did in 2016--win re-election, and then appoint a HHS secretary who will work to undermine the law as Idaho is trying http://money.cnn.com/2018/03/08/news/economy/idaho-obamacare/index.html

AdrianC

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Re: What comes after the ACA?
« Reply #4337 on: May 25, 2018, 05:44:31 AM »
Interesting piece:

Why Your Health Insurer Doesnít Care About Your Big Bills
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority.

https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. Thatís good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Hereís how: Letís say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

Itís like if a mom said told her son he could have 3 percent of a bowl of ice cream. A clever child would say, ďMake it a bigger bowl.Ē

Wonks call this a ďperverse incentive.Ē

katsiki

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Re: What comes after the ACA?
« Reply #4338 on: May 25, 2018, 05:59:34 AM »
Interesting piece:

Why Your Health Insurer Doesnít Care About Your Big Bills
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority.

https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. Thatís good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Hereís how: Letís say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

Itís like if a mom said told her son he could have 3 percent of a bowl of ice cream. A clever child would say, ďMake it a bigger bowl.Ē

Wonks call this a ďperverse incentive.Ē


Interesting read - thanks!

This lines up with an experience at my job.  My employer has started paying cash for many tests and procedures (might not be the right word - things like an MRI).  They found it is cheaper for them to do so than have the insurance company pay for it.  We have an interesting plan involving concierge care / direct primary care for many basic items.  I guess it is a form of self-insurance.  Working very well so far.
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swampwiz

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Re: What comes after the ACA?
« Reply #4339 on: May 25, 2018, 12:17:49 PM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?

Does this calculation take into account that circular issue that if you get a subsidy it lowers health insurance expense, which raises AGI, which then lowers the subsidy, which then in turn raises the AGI ?

https://obamacareguide.wordpress.com/2014/07/25/self-employed-health-insurance-deduction-the-iterative-calculation/
« Last Edit: May 25, 2018, 12:24:41 PM by swampwiz »

swampwiz

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Re: What comes after the ACA?
« Reply #4340 on: May 25, 2018, 12:22:29 PM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

What if I'm a pagan?
« Last Edit: May 25, 2018, 12:24:29 PM by swampwiz »

MDM

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Re: What comes after the ACA?
« Reply #4341 on: May 25, 2018, 12:56:15 PM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?

Does this calculation take into account that circular issue that if you get a subsidy it lowers health insurance expense, which raises AGI, which then lowers the subsidy, which then in turn raises the AGI ?

https://obamacareguide.wordpress.com/2014/07/25/self-employed-health-insurance-deduction-the-iterative-calculation/
Thanks.  I've looked at that and other sites.  So far the work required to code that in the spreadsheet has appeared too high.  Maybe some day....  Of course, if anyone is so inclined to provide a version of the case study spreadsheet that does include this, crediting that person for the upgrade is work I'd be happy to do. :)

boarder42

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Re: What comes after the ACA?
« Reply #4342 on: May 25, 2018, 01:09:55 PM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

What if I'm a pagan?

how can they prove that you are or not.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4343 on: May 25, 2018, 06:03:34 PM »
Thank you Swampwiz

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Re: What comes after the ACA?
« Reply #4344 on: May 27, 2018, 04:53:17 AM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

What if I'm a pagan?

how can they prove that you are or not.

They'd probably ask God to run a Soul Credit Check.
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Paul der Krake

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Re: What comes after the ACA?
« Reply #4345 on: May 27, 2018, 10:29:59 AM »
Interesting piece:

Why Your Health Insurer Doesnít Care About Your Big Bills
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority.

https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. Thatís good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Hereís how: Letís say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

Itís like if a mom said told her son he could have 3 percent of a bowl of ice cream. A clever child would say, ďMake it a bigger bowl.Ē

Wonks call this a ďperverse incentive.Ē

The arrogance of the hospital's attorney is incredible. The plaintiff is a bloody actuarial expert, he clearly understands the concept of modern medical billing like coinsurance.

DarkandStormy

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Re: What comes after the ACA?
« Reply #4346 on: June 08, 2018, 09:50:40 AM »
The federal government will not defend the ACA in court, putting 130 million Americans with pre-existing conditions at risk.

https://www.axios.com/trumps-justice-department-says-aca-is-unconstitutional-06f8714d-7606-4104-9982-f057786828a7.html

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The Justice Department will not defend the Affordable Care Act in court, and says it believes the law's individual mandate ó the provision the Supreme Court upheld in 2012 ó has become unconstitutional.
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Luck12

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Re: What comes after the ACA?
« Reply #4347 on: June 08, 2018, 10:26:51 AM »
Republicans are truly fucking evil.   Mobilize your friends, family, anybody you know that gives a shit about people to vote these assholes out this year and in 2020.       

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4348 on: June 08, 2018, 11:26:03 AM »
It's confusing what the implications are of a successful challenge to the individual mandate - but not defending those with pre-existing conditions could be devastating for millions of people. Moreover, most people are only temporarily able bodied.

FIRE@50

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Re: What comes after the ACA?
« Reply #4349 on: June 08, 2018, 11:30:49 AM »
I think the sooner the ACA dies, the sooner we will have a single payer system. I can only hope that not too many people are hurt during the transition.