Author Topic: What comes after the ACA?  (Read 825214 times)

EnjoyIt

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Re: What comes after the ACA?
« Reply #4800 on: September 23, 2018, 10:57:19 PM »
As for a national biking agency, very interesting though.

I realize this is a typo, yet enjoy that it would also be a quite effective way of reducing healthcare spending.

I giggled a little on this one.  National biking agency would definitely help decrease spending on healthcare on a per year basis.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4801 on: September 24, 2018, 09:03:45 AM »
The ACA did nothing to improve healthcare delivery in the country and even less in controlling cost of that delivery. 

Free preventive checkups, free vaccines, and other free preventive measures are an improvement to health care delivery in the country from a public health standpoint.

GuitarStv

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Re: What comes after the ACA?
« Reply #4802 on: September 24, 2018, 09:14:46 AM »
So, are we all in agreement for the need of a national biking agency then?

sol

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Re: What comes after the ACA?
« Reply #4803 on: September 24, 2018, 09:49:11 AM »
So, are we all in agreement for the need of a national biking agency then?

H.R. Giger aliens need not apply for agency leadership roles.  Down, boy.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4804 on: September 25, 2018, 12:08:54 AM »
So, are we all in agreement for the need of a national biking agency then?

I'm in. Everyone is healthier and we cut healthcare expenses using the extra money to provide affordable healthcare to everyone.

Done. After almost 5,000 posts we finally figured out how to fix healthcare in the US.

Exflyboy

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Re: What comes after the ACA?
« Reply #4805 on: September 25, 2018, 03:29:15 AM »
So, are we all in agreement for the need of a national biking agency then?

I'm in. Everyone is healthier and we cut healthcare expenses using the extra money to provide affordable healthcare to everyone.

Done. After almost 5,000 posts we finally figured out how to fix healthcare in the US.

Or at least link HC premiums to BMI

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4806 on: September 25, 2018, 08:24:47 AM »

Interesting thread on Bogleheads about the 2019 ACA premium increases and whether no penalty for not buying health insurance through the ACA is increasing the prices.

https://www.bogleheads.org/forum/viewtopic.php?f=2&t=259761

sol

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Re: What comes after the ACA?
« Reply #4807 on: September 25, 2018, 09:07:06 AM »
Or at least link HC premiums to BMI

Yea, because fuck weightlifters and tall people.  They should definitely pay more for basic medical care!

Paul der Krake

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Re: What comes after the ACA?
« Reply #4808 on: September 25, 2018, 09:21:50 AM »
But I have big bones.

talltexan

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Re: What comes after the ACA?
« Reply #4809 on: September 25, 2018, 11:35:07 AM »
Dude, I can't lift, run, or swim, BMI is the only number I'm any good at.

Threshkin

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Re: What comes after the ACA?
« Reply #4810 on: September 25, 2018, 03:58:39 PM »
So, are we all in agreement for the need of a national biking agency then?

I'm in. Everyone is healthier and we cut healthcare expenses using the extra money to provide affordable healthcare to everyone.

Done. After almost 5,000 posts we finally figured out how to fix healthcare in the US.

Or at least link HC premiums to BMI

Maybe not.

https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/

EnjoyIt

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Re: What comes after the ACA?
« Reply #4811 on: September 25, 2018, 08:22:13 PM »

Interesting thread on Bogleheads about the 2019 ACA premium increases and whether no penalty for not buying health insurance through the ACA is increasing the prices.

https://www.bogleheads.org/forum/viewtopic.php?f=2&t=259761

I was surprised it isn't locked completely. 
Personally I think the insurance companies are just trying to increase the price to as much as the market will tolerate.  I think there is still more room for price increases before the whole thing collapses under its largess.  Maybe another decade or so.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4812 on: September 25, 2018, 08:27:44 PM »

Interesting thread on Bogleheads about the 2019 ACA premium increases and whether no penalty for not buying health insurance through the ACA is increasing the prices.

https://www.bogleheads.org/forum/viewtopic.php?f=2&t=259761

I was surprised it isn't locked completely. 
Personally I think the insurance companies are just trying to increase the price to as much as the market will tolerate.  I think there is still more room for price increases before the whole thing collapses under its largess.  Maybe another decade or so.

Under the terms of the ACA, if insurance companies make more than 20% profit, they have to return that to the policy holders as a rebate.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4813 on: September 25, 2018, 09:13:12 PM »

Interesting thread on Bogleheads about the 2019 ACA premium increases and whether no penalty for not buying health insurance through the ACA is increasing the prices.

https://www.bogleheads.org/forum/viewtopic.php?f=2&t=259761

I was surprised it isn't locked completely. 
Personally I think the insurance companies are just trying to increase the price to as much as the market will tolerate.  I think there is still more room for price increases before the whole thing collapses under its largess.  Maybe another decade or so.

Under the terms of the ACA, if insurance companies make more than 20% profit, they have to return that to the policy holders as a rebate.

Profit = Proceeds - expenses.  If one increases expenses through stock buy back, management pay raises, hiring more staff, and etc the profits can nicely sit as close as possible to the 20% paying out a very tiny amount if need be.  Believe me, their goal is to not give that money up.  Also, if profits go up but expenses go up proportionately that will not change the percent profits.

Look at the SEC filing for any health insurance company and profits have been soaring over the years.  The ACA has been good to the insurance industry.  Exceptionally good to be more accurate.

On the other side, it seams like health insurance is about 2% of the holdings in VTI (Vanguard Total Stock Market index ETF.) Since those insurance companies are doing so well, stock prices are soaring and are increasing more than my premiums have been.  YEAH! (in a very sarcastic tone.) I guess that is the secret of being able to afford health insurance in retirement.  Have stocks in those insurance companies and pay from your proceeds.
« Last Edit: September 25, 2018, 09:45:47 PM by EnjoyIt »

seattlecyclone

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Re: What comes after the ACA?
« Reply #4814 on: September 25, 2018, 11:03:11 PM »

Interesting thread on Bogleheads about the 2019 ACA premium increases and whether no penalty for not buying health insurance through the ACA is increasing the prices.

https://www.bogleheads.org/forum/viewtopic.php?f=2&t=259761

I was surprised it isn't locked completely. 
Personally I think the insurance companies are just trying to increase the price to as much as the market will tolerate.  I think there is still more room for price increases before the whole thing collapses under its largess.  Maybe another decade or so.

Under the terms of the ACA, if insurance companies make more than 20% profit, they have to return that to the policy holders as a rebate.

Indeed, which means that the insurance company doesn't have much incentive to negotiate hard with doctors to reduce billed amounts. If they're already near the 80/20 ratio, every $1 they reduce member medical bills is 25 less profit they get, not to mention that the negotiators cost money. Does their salary count toward the 80%, or the 20%? If the latter, that's one more reason not to put much money into negotiating.

In essence, nobody in this system has much incentive to care about costs. The doctors are better off the more they can collect from patients and/or insurance companies. The insurance companies are better off the more their patients get charged, so long as they can get approval to raise their premiums enough to stay around the 80/20 ratio. The patients have most of their billed expenses covered by the insurance company. If they're paying only 10-20% coinsurance, capped at an out-of-pocket maximum, there's not a whole lot for the patient to gain by trying to negotiate things down either. Everyone in this system is playing with someone else's money and the result is utterly predictable.

pecunia

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Re: What comes after the ACA?
« Reply #4815 on: September 26, 2018, 05:16:07 PM »
[
In essence, nobody in this system has much incentive to care about costs. The doctors are better off the more they can collect from patients and/or insurance companies. The insurance companies are better off the more their patients get charged, so long as they can get approval to raise their premiums enough to stay around the 80/20 ratio. The patients have most of their billed expenses covered by the insurance company. If they're paying only 10-20% coinsurance, capped at an out-of-pocket maximum, there's not a whole lot for the patient to gain by trying to negotiate things down either. Everyone in this system is playing with someone else's money and the result is utterly predictable.

What is this predictable result?  It certainly sounds like a bubble ready to burst.  It's like 2008 and the market collapse.  When will this bubble burst?

seattlecyclone

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Re: What comes after the ACA?
« Reply #4816 on: September 26, 2018, 05:25:44 PM »
I was speaking of huge price increases year after year as the predictable result. Not sure what would cause the "bubble" to burst here, as it's not as though most of us will simply quit visiting doctors when we need to.

pecunia

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Re: What comes after the ACA?
« Reply #4817 on: September 27, 2018, 08:27:29 PM »
I was speaking of huge price increases year after year as the predictable result. Not sure what would cause the "bubble" to burst here, as it's not as though most of us will simply quit visiting doctors when we need to.

I would guess when people begin to die rather than visiting the doctor.  Remember the story on this post of the woman in Boston who was in a somewhat severe accident and her main concern was the price of the ambulance?  I would think there will be a critical point, a tipping point.  This point will be when a certain quantity of people die for lack of healthcare while seeing that there is another group of people who can get treated.  Healthcare may be available, but the price is so high that they choose the cruel alternative.  I would think when this problem reaches this tipping point, people will force a change.  The bubble will burst.

How close are we to that critical point?  Do we want to wait for the bubble to burst or just fix the problem now?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4818 on: September 27, 2018, 08:29:52 PM »
I was speaking of huge price increases year after year as the predictable result. Not sure what would cause the "bubble" to burst here, as it's not as though most of us will simply quit visiting doctors when we need to.

I would guess when people begin to die rather than visiting the doctor.  Remember the story on this post of the woman in Boston who was in a somewhat severe accident and her main concern was the price of the ambulance?  I would think there will be a critical point, a tipping point.  This point will be when a certain quantity of people die for lack of healthcare while seeing that there is another group of people who can get treated.  Healthcare may be available, but the price is so high that they choose the cruel alternative.  I would think when this problem reaches this tipping point, people will force a change.  The bubble will burst.

How close are we to that critical point?  Do we want to wait for the bubble to burst or just fix the problem now?


I hope people vote accordingly.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4819 on: September 28, 2018, 02:31:15 PM »
I was speaking of huge price increases year after year as the predictable result. Not sure what would cause the "bubble" to burst here, as it's not as though most of us will simply quit visiting doctors when we need to.

I would guess when people begin to die rather than visiting the doctor.  Remember the story on this post of the woman in Boston who was in a somewhat severe accident and her main concern was the price of the ambulance?  I would think there will be a critical point, a tipping point.  This point will be when a certain quantity of people die for lack of healthcare while seeing that there is another group of people who can get treated.  Healthcare may be available, but the price is so high that they choose the cruel alternative.  I would think when this problem reaches this tipping point, people will force a change.  The bubble will burst.

How close are we to that critical point?  Do we want to wait for the bubble to burst or just fix the problem now?

nah, that is not the tipping point.  To be brutally honest, most of society won't care if a few people choose to stay home and die instead of getting healthcare. They will be judged thereafter as making a poor decision. The tipping point is when the price of health insurance becomes so high that a large percentage of people opt out.  Without those people insurance premiums will have to go up again perpetuating a viscous cycle of opting and and premium raises.  This is our future if nothing changes and in my opinion we have maybe another decade before it gets to that point.

Lets be honest, a non-mustachian middle class dual income family will have to pay the full cost of health insurance.   today between premiums and high deductibles, out of pocket expenses can be as high as 15-20% of take home pay.  Every year they see premiums going up by 10-20% while noticing how useless the insurance is when actually paying for healthcare expenses due to the high deductible.  Since most middle class Americans live paycheck to paycheck eventually they will have to choose to cut spending somewhere and I believe at some point, health insurance will be on the chopping block especially when insurance appears to provide almost no value on a year to year basis for a relatively healthy family.

The bubble will burst eventually and the ACA has sped up the process due to speeding up the cost shifting on the middle class while the cost of administering healthcare keeps going up.

rantk81

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Re: What comes after the ACA?
« Reply #4820 on: September 29, 2018, 08:25:41 AM »
The tipping point is when the price of health insurance becomes so high that a large percentage of people opt out.  Without those people insurance premiums will have to go up again perpetuating a viscous cycle of opting and and premium raises.  This is our future if nothing changes and in my opinion we have maybe another decade before it gets to that point.

I think we are almost at that point.  With median family income around 60K/yr, and an unsubsidized premium of high deductible/out-of-pocket-max family plans running ~1500/mo (or more) in most areas with a 13K annual out of pocket max.... This typical family in a "heavy medical spending year" could be out 50% of their gross income from just medical insurance and out-of-pocket-costs -- if they are lucky enough that everything is provided by an in-network provider.

Now that there will be no more tax penalty for "opting out" in 2019, I would anticipate that this accelerates.

« Last Edit: September 29, 2018, 08:42:37 AM by rantk81 »

pecunia

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Re: What comes after the ACA?
« Reply #4821 on: September 29, 2018, 03:57:46 PM »

I think we are almost at that point.  With median family income around 60K/yr, and an unsubsidized premium of high deductible/out-of-pocket-max family plans running ~1500/mo (or more) in most areas with a 13K annual out of pocket max.... This typical family in a "heavy medical spending year" could be out 50% of their gross income from just medical insurance and out-of-pocket-costs -- if they are lucky enough that everything is provided by an in-network provider.

Now that there will be no more tax penalty for "opting out" in 2019, I would anticipate that this accelerates.


If people can't afford insurance and many will default on high medical bills, I guess this will mean health care providers will need to make up that difference somehow.  So their charge rates will go up.  Then the remaining insurance companies will need to pay this and the premiums will go up.

Is insurance at all like other commodities with supply and demand curves?  If people stop buying their products, is there a possibility that they will lower prices to attract customers?  I guess they won't be able to do this since their costs will be rising.

If this occurs as predicted, many people will experience an additional hardship in their lives.

At this time, I will be looking at the arguments made for the free market medical system that we have in the US.  It will be interesting.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4822 on: September 30, 2018, 01:01:09 PM »

I think we are almost at that point.  With median family income around 60K/yr, and an unsubsidized premium of high deductible/out-of-pocket-max family plans running ~1500/mo (or more) in most areas with a 13K annual out of pocket max.... This typical family in a "heavy medical spending year" could be out 50% of their gross income from just medical insurance and out-of-pocket-costs -- if they are lucky enough that everything is provided by an in-network provider.

Now that there will be no more tax penalty for "opting out" in 2019, I would anticipate that this accelerates.


If people can't afford insurance and many will default on high medical bills, I guess this will mean health care providers will need to make up that difference somehow.  So their charge rates will go up.  Then the remaining insurance companies will need to pay this and the premiums will go up.

Is insurance at all like other commodities with supply and demand curves?  If people stop buying their products, is there a possibility that they will lower prices to attract customers?  I guess they won't be able to do this since their costs will be rising.

If this occurs as predicted, many people will experience an additional hardship in their lives.

At this time, I will be looking at the arguments made for the free market medical system that we have in the US.  It will be interesting.

Healthcare in the US does not follow any capitalistic structure.  It is a blend of corrupt socialism with corrupt capitalism intertwined.  It is failing miserably.  The more I keep looking at it, the more I feel it may very well be the cause of our next recession.

The people who should be fighting to fix the system, the doctors, are too debt ridden and too scared to cause any waves since they so heavily depend on their income.  If more physicians adopted mustachian thinking, they could easily band together and fight.  Imagine if 25% of the doctors said NO! We want transparency, we want insurance to get out of our way and stop being the middle man bookie.  We want to stop running useless tests on everyone because we are too scared of the consequences. We want to stop wasting our time documented useless shit just so that we can pay the insurance/CMS billing game. If the system doesn't change we will stop working. 

pecunia

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Re: What comes after the ACA?
« Reply #4823 on: September 30, 2018, 01:18:38 PM »

Healthcare in the US does not follow any capitalistic structure.  It is a blend of corrupt socialism with corrupt capitalism intertwined.  It is failing miserably.  The more I keep looking at it, the more I feel it may very well be the cause of our next recession.

The people who should be fighting to fix the system, the doctors, are too debt ridden and too scared to cause any waves since they so heavily depend on their income.  If more physicians adopted mustachian thinking, they could easily band together and fight.  Imagine if 25% of the doctors said NO! We want transparency, we want insurance to get out of our way and stop being the middle man bookie.  We want to stop running useless tests on everyone because we are too scared of the consequences. We want to stop wasting our time documented useless shit just so that we can pay the insurance/CMS billing game. If the system doesn't change we will stop working. 

"It is a blend of corrupt socialism with corrupt capitalism intertwined."  I loved that sentence.  It sounds like you are a doctor as you say "we" will stop working.  I am not a doctor, but I would love to have that sort of income for a few years.  It could make barely imagined dreams come true.  It would be hard to give that income up.  Golden Handcuffs do exist.

Aren't there a lot of doctors who would like to see the system change?  I've read there are a lot of nurses who want the system revised.  Maybe, the doctors ought to rise up and change this system.  I'll bet a doctor's strike would get a LOT of attention.

sol

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Re: What comes after the ACA?
« Reply #4824 on: September 30, 2018, 02:04:34 PM »
I'll bet a doctor's strike would get a LOT of attention.

Doctor's can't strike, at least not in the traditional sense.  Imagine carrying your bleeding child, clinging to life, into the emergency room and the receptionist says "sorry, the doctors are all out on the picket line today."

EnjoyIt

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Re: What comes after the ACA?
« Reply #4825 on: September 30, 2018, 04:13:41 PM »
I'll bet a doctor's strike would get a LOT of attention.

Doctor's can't strike, at least not in the traditional sense.  Imagine carrying your bleeding child, clinging to life, into the emergency room and the receptionist says "sorry, the doctors are all out on the picket line today."

Doctors can't strike, but we sure can slow down and close our offices to go on vacation.  We can refuse new consults, we can do a lot and the world would have to listen.  But, Pecunia has it right, the golden handcuffs are real, and the debt that doctors get themselves into is even more real which makes the idea of a slow down likely impossible to achieve.  Like most American's, most doctors live paycheck to paycheck with lots of debt.

maizeman

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Re: What comes after the ACA?
« Reply #4826 on: September 30, 2018, 04:22:33 PM »
Groups of doctors can strike and do in other countries, for example in the UK in 2016. Of course these were Europe style strikes with defined start and end points and "reduced services" rather than completely walking off the job. The first couple of times the striking doctors only went on strike from elective procedures. The last time, the strike included both elective and emergency procedures.

The bigger problem for doctors in the USA is who would they be striking against?

Their patients? The patients don't have any power to change the system, at least not in the time frame of a strike itself.
The insurance companies? Insurers would make more money, not less, patients aren't able to get treatment.
The government? Our government is so deadlocked it cannot manage to actually do much of anything that the party that controls all three branches of government WANTS to do, let alone anything it is being forced to do by external pressure.

swampwiz

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Re: What comes after the ACA?
« Reply #4827 on: September 30, 2018, 08:39:12 PM »
With median family income around 60K/yr, and an unsubsidized premium of high deductible/out-of-pocket-max family plans running ~1500/mo (or more) in most areas with a 13K annual out of pocket max.... This typical family in a "heavy medical spending year" could be out 50% of their gross income from just medical insurance and out-of-pocket-costs -- if they are lucky enough that everything is provided by an in-network provider.

Now that there will be no more tax penalty for "opting out" in 2019, I would anticipate that this accelerates.

As a single, no-family "welfare Rother" at an early AARP-eligible age, I have calculated that in a typical year, the value of my FREE ObamaRomneyHeritageCare Medicaid expansion would be about $20K of gross income were I above the 400% of poverty premium tax credit cliff.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4828 on: October 01, 2018, 08:32:19 PM »
Interesting column: https://www.axios.com/corporate-health-costs-not-crisis-86bdd8ec-0d53-4d3c-b29c-b39791b8be5f.html

Not sure why the author says he doesn't get the corporate anxiety. He explains in the very same article that corporations have been able, so far, to shift the cost increase onto employees and fear they've reached the limit. Personally, I'm shocked by some of the case studies we see here where employers only pick up something like 50% or less of the premiums. Guess it's better than nothing...

rantk81

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Re: What comes after the ACA?
« Reply #4829 on: October 02, 2018, 06:07:38 AM »
Interesting column: https://www.axios.com/corporate-health-costs-not-crisis-86bdd8ec-0d53-4d3c-b29c-b39791b8be5f.html

Not sure why the author says he doesn't get the corporate anxiety. He explains in the very same article that corporations have been able, so far, to shift the cost increase onto employees and fear they've reached the limit. Personally, I'm shocked by some of the case studies we see here where employers only pick up something like 50% or less of the premiums. Guess it's better than nothing...

My employer has certainly been shifting a ton of the cost to employees.  For the 2018 plan year, it has
- 3000 deductible (not too bad)
- then with 70% co-insurance (not great)
- in a very tiny network of doctors (not great)
- and with a 10,000 out of pocket max (terrible)

This plan would be pretty bad even if the employer subsidized the entire premium cost... but they don't.  My co-workers DEFINITELY notice and complain a lot around open-enrollment-time.

When I started working here a little over a decade ago, I could see just about any doctor/hospital in the whole city, I had a $400 deductible, with $10 doctor visit copays, 90% co-insurance, and $1200 out of pocket max. LOL.
« Last Edit: October 02, 2018, 06:20:43 AM by rantk81 »

katsiki

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Re: What comes after the ACA?
« Reply #4830 on: October 02, 2018, 08:07:16 AM »
Not sure if this helps but my employer is going the other way.  We switched to a HDHP plan where the employer covers copays, prescriptions, etc.  Primary care and some related items (tests, etc) are covered by a direct primary care (concierge) medical office.  It has been a little more than a year and it is working well.

We are finding that the insurer who holds the HDHP is shifting costs on some services.  ie MRI, etc.  They are trying to find a way to do those outside of the plan too.

It is a crazy game everyone has to play.  My employer is relatively small.  It makes me wonder why we cannot fix healthcare if we can do this on a small scale ourselves.


pecunia

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Re: What comes after the ACA?
« Reply #4831 on: October 02, 2018, 05:54:23 PM »
Not sure if this helps but my employer is going the other way.  We switched to a HDHP plan where the employer covers copays, prescriptions, etc.  Primary care and some related items (tests, etc) are covered by a direct primary care (concierge) medical office.  It has been a little more than a year and it is working well.

We are finding that the insurer who holds the HDHP is shifting costs on some services.  ie MRI, etc.  They are trying to find a way to do those outside of the plan too.

It is a crazy game everyone has to play.  My employer is relatively small.  It makes me wonder why we cannot fix healthcare if we can do this on a small scale ourselves.



"It makes me wonder why we cannot fix healthcare" - I think we can.

rantk81

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Re: What comes after the ACA?
« Reply #4832 on: October 10, 2018, 01:28:46 PM »
USA Today published an op-ed today, supposedly from Trump, about Medicare.  It seems to have a lot of... (how do i say this elegantly??...) lies, in it.

https://www.usatoday.com/story/opinion/2018/10/10/donald-trump-democrats-open-borders-medicare-all-single-payer-column/1560533002/


pecunia

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Re: What comes after the ACA?
« Reply #4833 on: October 10, 2018, 05:27:22 PM »
USA Today published an op-ed today, supposedly from Trump, about Medicare.  It seems to have a lot of... (how do i say this elegantly??...) lies, in it.

https://www.usatoday.com/story/opinion/2018/10/10/donald-trump-democrats-open-borders-medicare-all-single-payer-column/1560533002/


The story is an excellent example of "fake" news.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4834 on: October 10, 2018, 09:48:12 PM »
USA Today published an op-ed today, supposedly from Trump, about Medicare.  It seems to have a lot of... (how do i say this elegantly??...) lies, in it.

https://www.usatoday.com/story/opinion/2018/10/10/donald-trump-democrats-open-borders-medicare-all-single-payer-column/1560533002/


The story is an excellent example of "fake" news.

Just another piece of partisan bullshit legislature that does nothing but transfer who will pay for our overpriced healthcare as opposed to do something to control cost.

BTW, I am for a single payer healthcare system that covers basic low cost healthcare needs for US citizens and legal immigrants.

happyfeet

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Re: What comes after the ACA?
« Reply #4835 on: October 12, 2018, 08:54:14 AM »
Finishing out my last year of COBRA after a divorce of a long term marriage as a SAHM.

I am 60.  COBRA is excellent coverage - MEGA company of Ex. Paying $550 a month for COBRA.  Called broker today for idea of ACA.

$900 a month for a Silver Plan with an $8000 deductible.

Pretty unaffordable as you age.  I am in a state with lots of ACA choices too.

IDK - could get interesting next year. I am in favor of a single payor plan and will vote accordingly come Nov.

Totally off topic but while still married, I found this site, and moved all the investments from a broker to Vanguard and really learned how to cut costs and still have a great life.  Thanks MMM peeps.
« Last Edit: October 12, 2018, 08:58:24 AM by happyfeet »

geekette

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Re: What comes after the ACA?
« Reply #4836 on: October 12, 2018, 09:14:39 AM »
What's your income vs. the Federal Poverty Level?  If you're under ~$48k, you may be eligible for subsidies. 

happyfeet

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Re: What comes after the ACA?
« Reply #4837 on: October 13, 2018, 07:07:53 AM »
Not eligible  for subsidies based on my alimony and my income as those together are about $55,000.  However, should he retire and we split his pension, then I would be eligible.  I recognize that without ACA I would really be in trouble with my pre existing condition, but the cost as a portion of my income, ACA is quite high. 

chasesfish

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Re: What comes after the ACA?
« Reply #4838 on: October 13, 2018, 07:22:10 AM »
How long before we get a non-polarizing leader that can convince each side to come together with an adequate solution?

Guaranteed coverage without a mandate just produced what we expected, unaffordable insurance

pecunia

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Re: What comes after the ACA?
« Reply #4839 on: October 13, 2018, 12:52:05 PM »
Not eligible  for subsidies based on my alimony and my income as those together are about $55,000.  However, should he retire and we split his pension, then I would be eligible.  I recognize that without ACA I would really be in trouble with my pre existing condition, but the cost as a portion of my income, ACA is quite high. 

Jeepers - $55,000 income - $48,000 cutoff = $7,000  Make $7,000 less and you get reduced insurance.

$900 / month premium X 12 months = $10,800 yearly premium 

You would still have to pay something with Obamacare, but ignoring that amount ($100 / month?), it sure does look like a disincentive to work.

Government programs should not remove the incentive to work.  If we did the healthcare for all thing, there is a good chance this sort of disincentive would be removed.

I'd guess the solution offered by the current crew of pirating politicians would be to eliminate Obamacare.  They would use the excuse of this program being a disincentive to work as the reason.


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Re: What comes after the ACA?
« Reply #4840 on: October 13, 2018, 12:57:39 PM »
Not eligible  for subsidies based on my alimony and my income as those together are about $55,000.  However, should he retire and we split his pension, then I would be eligible.  I recognize that without ACA I would really be in trouble with my pre existing condition, but the cost as a portion of my income, ACA is quite high.

Could you afford to max out an HSA contribution?.. That would reduce your MAGI by around $8,000, thus make you eligible for a subsidy.

Of course you would have to have a high deductible plan which may not work with your expected spend on healthcare.

What a wonderful system we have!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4841 on: October 13, 2018, 06:24:31 PM »
IF any of this is earned income then it would make sense to do a traditional IRA to lower your AGI so that you could qualify for subsidies.

happyfeet

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Re: What comes after the ACA?
« Reply #4842 on: October 13, 2018, 09:04:42 PM »
It is all earned income(alimony and my job).  From what I read, ACA uses MAGI, which is different from AGI.  MAGI adds back in any traditional IRA deduction.  The only deduction that MAGI appears to be the HSA one if I chose a high deductible insurance plan, which I will probably do.  And it appears that the working actually is what will put me above the $48,000.  Go figure. 

My COBRA expires 3/2020, so I will do enrollment then as a qualifying event.

The costs are frightening. Not how I planned on spending my retirement money.




seattlecyclone

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Re: What comes after the ACA?
« Reply #4843 on: October 13, 2018, 10:02:52 PM »
It is all earned income(alimony and my job).  From what I read, ACA uses MAGI, which is different from AGI.  MAGI adds back in any traditional IRA deduction.  The only deduction that MAGI appears to be the HSA one if I chose a high deductible insurance plan, which I will probably do.  And it appears that the working actually is what will put me above the $48,000.  Go figure. 

"AGI" is a well-defined term. It's the number that you report on the bottom of the first page of your 1040. "MAGI" is different. It's the AGI, modified in a certain way. There are different MAGI calculations for different purposes. The MAGI used for determining your IRA deduction does add the IRA deduction back in; the MAGI used for the ACA subsidies does not. For the ACA, IRA deductions are fair game as a way to reduce your income.

Exflyboy

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Re: What comes after the ACA?
« Reply #4844 on: October 14, 2018, 07:55:13 AM »
MAGI for the ACA is clearly explained here:

http://laborcenter.berkeley.edu/pdf/2013/MAGI_summary13.pdf

Yes you can use both traditional IRA plus HSA deductions to get you under the subsidy wire.

happyfeet

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Re: What comes after the ACA?
« Reply #4845 on: October 14, 2018, 07:59:29 AM »
Thank you so  much.  I will use both of those as I have enough money outside the traditional IRA to fund that for the three plus years to age 65.

Probably cut down on work hours too.

Grateful I understand LBYM, and the power of saving  money.

Exflyboy

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Re: What comes after the ACA?
« Reply #4846 on: October 14, 2018, 08:10:50 AM »
Oh yes, on the IRA you are limited to either the max contribution ($5500 or $6500 if over 50) OR the total of your earned income whichever is lower.

So if by chance your job only paid you $4000 for this year than that would be your max contribution.

The HSA you can contribute the max to regardless of your income.$3450 self only or $6900 for a family... plus $1000 catch up contribution if over 55.

happyfeet

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Re: What comes after the ACA?
« Reply #4847 on: October 14, 2018, 05:18:49 PM »
I can contribute to an IRA with funds from my alimony as I pay federal and state taxes on the amount. My tax accountant cleared that one for me.  I was divorced several years ago.

So with the HSA and IRA I will have a nice deduction to lower my MAGI!

Exflyboy

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Re: What comes after the ACA?
« Reply #4848 on: October 16, 2018, 10:35:21 AM »
Yes indeed.. You can make yourself almost poor!.. I know I do..:)

DreamFIRE

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Re: What comes after the ACA?
« Reply #4849 on: October 17, 2018, 04:32:30 PM »

McConnell speaks again about repealing the ACA if they get the votes as well as slashing Medicare and Social Security.

https://www.cnbc.com/2018/10/17/mcconnell-says-senate-republicans-might-revisit-obamacare-repeal.html