What comes after the ACA?

[Metric Mouse]

That would be completely unsustainable.  Which is why we would need death panels to keep the population in check

Whew. Good thing the ACA has thought of everything!

[fuzzy math]

Have you considered just dying if you get sick?

I wouldn't even need to get sick if the insurance companies had their profit caps removed and my premiums ended up costing 50% of my estimated retirement expenses. That alone might kill me.

[accolay]

Back to the original question again: What comes after the ACA?

The leaked draft from yesterday:
http://www.vox.com/policy-and-politics/2017/2/24/14726916/leaked-republican-obamacare-replacement-plan-explained

The same shit we had before- worse with a push to eventually privatize medicare. After forcing this garbage through and the failure it will be, they'll claim the government can't possibly manage this problem and the private market better take over.

Preexisting conditions are back. People getting divorced, going bankrupt for medical bills. Those 20 million who now have insurance? Gone. Larger price increases every year. No better outcomes to achieve nationally. Locked into your job for insurance.

Oh, the halcyon days of Obamacare past.

[Roland of Gilead]

I will heavily research the bankruptcy laws and how to maximize protection of assets using 401K and IRA (maybe an annuity too).  Sure, it won't work in all cases but with over $120,000 available in unsecured credit we could probably string along $150,000 to $200,000 of bills and then bail on them, falling back on our 401K and IRA protected monies after bankruptcy.    Beats working as a Walmart greeter in your 70s.

[the_fixer]

I have a feeling health insurance will make or break my ability to retire.

I can't even begin to project. How can anyone short of 2 million feel comfortable retiring with all the wild fluctuations floated as plans? It could make a huge difference for most of us.

Have you considered just dying if you get sick?

Surely with universal health insurance no one would ever get fatally ill!

That would be completely unsustainable.  Which is why we would need death panels to keep the population in check

Where do I stand in line for my ration of Soylent Green?

[Classical_Liberal]

I will heavily research the bankruptcy laws and how to maximize protection of assets using 401K and IRA (maybe an annuity too).  Sure, it won't work in all cases but with over $120,000 available in unsecured credit we could probably string along $150,000 to $200,000 of bills and then bail on them, falling back on our 401K and IRA protected monies after bankruptcy.    Beats working as a Walmart greeter in your 70s.

Ha! dont forget your primary residence!  I'm a renter, but if I get sick you can bet your ass my post tax $ are buying a McMansion before I go to bankruptcy court.

[NoStacheOhio]

But doesn't this tax only effect very highly compensated employees

No, and that's the problem.  Your employer typically pays around $10k to subsidize your health insurance, regardless of what your pay rate is.  This proposal is much closer to a flat tax, the same number of dollars from every person, than it is to income tax, where the highly compensated pay more.  Republicans love flat taxes, because they are so regressive.  They are better for rich people.

I guess my understanding is different - this tax (which was going to go into effect anyway, though at a different rate) would not affect everyone - just plans that are above the 90% price threshold. So only the top 10% of most expensive plans would be taxed - i.e. rich people. (And also, as you mentioned, unions, who have negotiated these very expensive plans into their benefit packages).  So it may be 'flat', but would be shouldered generally by the highest-compensated employees; it's not a flat tax on everyone, or even the 'typical' employee (to use your term) with employer-sponsored health insurance.

Does that only apply to plans purchased from a third party?

I work at a hospital, and we're self insured. Our coverage is fucking outstanding. They keep jacking the copays, but basically anything in-network (or emergency) is covered 100% with no coinsurance. Our hospital pharmacies are also dirt-cheap. I don't understand how this isn't "Cadillac." I pay less for up to three dependents than some people pay for a crappy solo plan.

[Metric Mouse]

It may depend upon the formula used to calculate the price of your insurance. I don't think that it matters how much you oay, as much as it matters how much the overall premiums are.

In futher research: the Cadillac Tax was originally opposed by republicans because it was indexed to inflation. As premiums rise much, much faster than inflation under the ACA, a larger and larger percentage of Americans would fall under this tax as time went on. Originally Republicans opposed this as they felt middle class Americans should not be subject to this tax. Democrats opposed it because their corporate and union lobby interests opposed it. Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it. Without this the ACA would not be solvent.  So now the answer to a broken Democrat plan based on a Republican plan seems to be an Obama tax that no one wanted to begin with.

So that's where this sits. Obviously the Republican replacement plan is in its infancy and will likely change much as ut moves through the committees, but that is the direction it is heading currently.

[nereo]

I have a feeling health insurance will make or break my ability to retire.

I can't even begin to project. How can anyone short of 2 million feel comfortable retiring with all the wild fluctuations floated as plans? It could make a huge difference for most of us.

Personally I think a tad dramatic (though I guess knowing how much your 'base retirement 'stach is changes the equation).
If I were no ACA provisions were in place and I were forced to pay for a non-subsidized, non-employer-sponsored health care plan for my spouse and I it would probably be in the neighborhood of $15k-20k per year with reasonable coverage.  Let's go with the higher number. That's an extra $500k to pay for that in perpetuity, for an absolute worst-case-scenario.

Of course with that much in a "health-care bucket" it would be tempting just to self insure.

[gerardc]

The fundamental problem with health insurance is that most insured events are not well-defined points in time like other forms of insurance (theft, death, accident, fire, etc.) but spread out over time, e.g. you hurt your back, a few weeks later you relapse and it becomes chronic; it's often hard to follow the series of causes and effects. It it were, we could force insurance companies to cover costs for all treatments related to some illness, no matter how long it lasts, e.g. you get cancer under some plan, you get treated even if it takes 10 years. This would make health insurance just as simple as other forms of insurance. "Pre-existing conditions" wouldn't even be relevant.

[radram]

This would make health insurance just as simple as other forms of insurance. "Pre-existing conditions" wouldn't even be relevant.

I see the exact opposite conclusion.

NOTHING would be covered because EVERYTHING will be claimed to be pre-exsisting, and therefore not the responsibility of the current ensurer.

[gerardc]

NOTHING would be covered because EVERYTHING will be claimed to be pre-exsisting, and therefore not the responsibility of the current ensurer.

Which is fine, the previous insurer would pay for it. It would incentivize people to be covered at all times, as they should be.

If your car has some defect, I'm sure you don't except you can just hop on an insurance policy and get it repaired for free? But if it is the result of a previous accident for which you were insured, you'll get reimbursed.

[AdrianC]

If I were no ACA provisions were in place and I were forced to pay for a non-subsidized, non-employer-sponsored health care plan for my spouse and I it would probably be in the neighborhood of $15k-20k per year with reasonable coverage.  Let's go with the higher number. That's an extra $500k to pay for that in perpetuity, for an absolute worst-case-scenario.

Of course with that much in a "health-care bucket" it would be tempting just to self insure.

I've thought along similar lines. The problem being how to get the same or lower costs for services as the insurance companies pay. We had this problem when we lost dental (thanks, Obama!). We bought a Cigna plus dental discount card and get reasonable rates at our dentist.

The latest Republican proposal does include tax credits. You and spouse could get up to $7k a year. Could get you a bare bones catastrophic plan and self insure the rest through an HSA. That's a reasonable scenario for early retirement, perhaps.

[gerardc]

Are the tax credits based solely on income, not net worth?

[obstinate]

Which is fine, the previous insurer would pay for it. It would incentivize people to be covered at all times, as they should be.

If your car has some defect, I'm sure you don't except you can just hop on an insurance policy and get it repaired for free? But if it is the result of a previous accident for which you were insured, you'll get reimbursed.

Insurance doesn't cover car defects, precisely because it's very difficult to know when they started or who should be responsible. Car insurance covers collisions and liability. This idea of yours would not work.

[Monkey Uncle]

I have a feeling health insurance will make or break my ability to retire.

I can't even begin to project. How can anyone short of 2 million feel comfortable retiring with all the wild fluctuations floated as plans? It could make a huge difference for most of us.

Personally I think a tad dramatic (though I guess knowing how much your 'base retirement 'stach is changes the equation).
If I were no ACA provisions were in place and I were forced to pay for a non-subsidized, non-employer-sponsored health care plan for my spouse and I it would probably be in the neighborhood of $15k-20k per year with reasonable coverage.  Let's go with the higher number. That's an extra $500k to pay for that in perpetuity, for an absolute worst-case-scenario.

Of course with that much in a "health-care bucket" it would be tempting just to self insure.

Everyone's numbers will vary based on their individual situation, but I think the basic point is the same: those of us who factored subsidized ACA insurance into our FIRE plans will be working longer than we planned.

For me personally, my best guess (assuming costs roughly equivalent to an unsubsidized silver ACA plan) is that insurance for DW and me would be about $21k per year, which is about $17k more than I planned, and causes total spending to exceed the modeled max sustainable amount by about $10k.  That would require adding $250k to the stash to cover a 30 year retirement.  But it's more complicated than that, because we will be eligible for Medicare sooner than that(assuming it still exists), and presumably our costs would decline back to a more "normal" amount at that time.  I haven't yet done the research necessary to run those numbers.  I guess I'm still in denial and hoping the whole "repeal and replace" thing blows up in the repubs' faces.

I suppose I shouldn't be upset about not being able to get a freebie that is subsidized by folks who are still working.  But I had kind of hoped that the ACA was the bridge that was going to lead the US to single payer eventually, and the work-discouraging subsidies were a necessary tool for facilitating that transition.  Oh well, I guess I'd better get used to the thought of being chained to my desk for several more years.

[Mr Mark]

I have a feeling health insurance will make or break my ability to retire.

I can't even begin to project. How can anyone short of 2 million feel comfortable retiring with all the wild fluctuations floated as plans? It could make a huge difference for most of us.

Personally I think a tad dramatic (though I guess knowing how much your 'base retirement 'stach is changes the equation).
If I were no ACA provisions were in place and I were forced to pay for a non-subsidized, non-employer-sponsored health care plan for my spouse and I it would probably be in the neighborhood of $15k-20k per year with reasonable coverage.  Let's go with the higher number. That's an extra $500k to pay for that in perpetuity, for an absolute worst-case-scenario.

Of course with that much in a "health-care bucket" it would be tempting just to self insure.

Everyone's numbers will vary based on their individual situation, but I think the basic point is the same: those of us who factored subsidized ACA insurance into our FIRE plans will be working longer than we planned.

For me personally, my best guess (assuming costs roughly equivalent to an unsubsidized silver ACA plan) is that insurance for DW and me would be about $21k per year, which is about $17k more than I planned, and causes total spending to exceed the modeled max sustainable amount by about $10k.  That would require adding $250k to the stash to cover a 30 year retirement.  But it's more complicated than that, because we will be eligible for Medicare sooner than that(assuming it still exists), and presumably our costs would decline back to a more "normal" amount at that time.  I haven't yet done the research necessary to run those numbers.  I guess I'm still in denial and hoping the whole "repeal and replace" thing blows up in the repubs' faces.

I suppose I shouldn't be upset about not being able to get a freebie that is subsidized by folks who are still working.  But I had kind of hoped that the ACA was the bridge that was going to lead the US to single payer eventually, and the work-discouraging subsidies were a necessary tool for facilitating that transition.  Oh well, I guess I'd better get used to the thought of being chained to my desk for several more years.

Won't there then be a return to the old 'catastophic only policies' with high deductibles that MMM used on his FIRE?

Fortunately it looks increasingly as if the GOP like being re-elected even more than they like gutting social safety nets, so the changes may be small enough to just be able to claim with a straight face (and a lot of spin) that Trump/Ryancare is huuuuugely improved on that old Obamacare disaster and there, I fixed it. It's now great (if suspiciously the same as it was before). Afterall it was always essentially a republican right wing conservative plan.

The big hit will depend on (a)which State you're in and (b)if you are so poor you're dependant on Medicare.

[Classical_Liberal]

Everyone's numbers will vary based on their individual situation, but I think the basic point is the same: those of us who factored subsidized ACA insurance into our FIRE plans will be working longer than we planned.

For me personally, my best guess (assuming costs roughly equivalent to an unsubsidized silver ACA plan) is that insurance for DW and me would be about $21k per year, which is about $17k more than I planned, and causes total spending to exceed the modeled max sustainable amount by about $10k.  That would require adding $250k to the stash to cover a 30 year retirement.  But it's more complicated than that, because we will be eligible for Medicare sooner than that(assuming it still exists), and presumably our costs would decline back to a more "normal" amount at that time.  I haven't yet done the research necessary to run those numbers.  I guess I'm still in denial and hoping the whole "repeal and replace" thing blows up in the repubs' faces.

Death of the ACA is obviously a big blow to anyone who planned to FIRE with spending that was modest enough to qualify for subsidies. This goes doubly so for anyone with a preexisting condition that increases premiums.  On an optimistic side, prior to ACA many states had found semi-viable solutions for high risk, low income people.  Once this all shakes out, the more progressive states will likely pick up where they had left off. This could open up some geographic arbitrage opportunities for those in your position.  Don't give up!

[Mr Mark]

Oh, and btw, New Zealand seems able (via the magic of single payer combined with suplimental top up insurance if you want it) to provide pretty ok health care for everyone, despite being a moderately wealthy country, a population of just under 5 million people, and a max tax rate of 33%. https://en.wikipedia.org/wiki/Health_care_in_New_Zealand

Why couldn't a democratic and/or enlightened US State manage to bring in their own version of single payer or ACA and fix the problem directly? (perhaps with minimum State residency requirements). Why does it have to be a Federal/Pan-USA thing? Isn't this what Mitt Romney did?

[AdrianC]

Are the tax credits based solely on income, not net worth?

The ACA subsidies are based on income. I haven't qualified yet. In the latest Republican proposal the tax credits are age based. Income or net worth isn't a factor.

I'm not sure why all the doom and gloom. If the final law looks like the proposal my family will get $12k in tax credits and will likely be able to buy a catastrophic plan. We'll cover normal medical expenses via an HSA. Other proposals are pushing for higher limits on HSAs, which will help us even more.

[radram]

NOTHING would be covered because EVERYTHING will be claimed to be pre-exsisting, and therefore not the responsibility of the current ensurer.

Which is fine, the previous insurer would pay for it. It would incentivize people to be covered at all times, as they should be.

If your car has some defect, I'm sure you don't except you can just hop on an insurance policy and get it repaired for free? But if it is the result of a previous accident for which you were insured, you'll get reimbursed.

You believe that if you go to your previous auto insurer and tell them, "fix this, it happened while I was insured with you", that they would just say, "ok, here is the check". Have you ever done this, or ever heard of anyone that ever has? A health issue might have begun YEARS ago.

You will most likely be in a limbo-land, with 2 healthcare companies pointing fingers saying "they did it". I have dealt with 1 healthcare company to get coverage. I can not fathom dealing with 2.

And yes, people try to defraud their auto insurance company all the time. Do you really want to be accused or charged with fraud in order to get health services? Accusation of fraud could be a likely outcome of attempting to get either carrier to pay.

[Monkey Uncle]

Everyone's numbers will vary based on their individual situation, but I think the basic point is the same: those of us who factored subsidized ACA insurance into our FIRE plans will be working longer than we planned.

For me personally, my best guess (assuming costs roughly equivalent to an unsubsidized silver ACA plan) is that insurance for DW and me would be about $21k per year, which is about $17k more than I planned, and causes total spending to exceed the modeled max sustainable amount by about $10k.  That would require adding $250k to the stash to cover a 30 year retirement.  But it's more complicated than that, because we will be eligible for Medicare sooner than that(assuming it still exists), and presumably our costs would decline back to a more "normal" amount at that time.  I haven't yet done the research necessary to run those numbers.  I guess I'm still in denial and hoping the whole "repeal and replace" thing blows up in the repubs' faces.

Death of the ACA is obviously a big blow to anyone who planned to FIRE with spending that was modest enough to qualify for subsidies. This goes doubly so for anyone with a preexisting condition that increases premiums.  On an optimistic side, prior to ACA many states had found semi-viable solutions for high risk, low income people.  Once this all shakes out, the more progressive states will likely pick up where they had left off. This could open up some geographic arbitrage opportunities for those in your position.  Don't give up!

I'm in West Virginia, which has never had a reputation for progressivity, and since 2012 has been largely taken over by nutcase tea party types (with the mostly powerless governor's chair being the odd exception).  So I don't hold out a lot of hope for my state government coming up with a well-reasoned solution.  Moving elsewhere would likely result in COL increases in other areas besides health care.  I'm not trying to throw cold water on your optimism, and I truly appreciate the encouragement, but I gotta be realistic.

The one saving grace may be the fact that WV accepted the Medicaid expansion just before the Democrats got booted out of the statehouse.  The prospect of 10s of thousands of poor people losing their recently gained medical coverage might be enough to make even the die-hard tea baggers think twice about pulling the plug on everything.  Of course, they could just keep the Medicaid coverage and give everyone else the shaft.

[Monkey Uncle]

Are the tax credits based solely on income, not net worth?

The ACA subsidies are based on income. I haven't qualified yet. In the latest Republican proposal the tax credits are age based. Income or net worth isn't a factor.

I'm not sure why all the doom and gloom. If the final law looks like the proposal my family will get $12k in tax credits and will likely be able to buy a catastrophic plan. We'll cover normal medical expenses via an HSA. Other proposals are pushing for higher limits on HSAs, which will help us even more.

If I read the article about the republican plan correctly, the most DW and I could get would be $8k in tax credits (probably less), which would not cover my projected $17k increase in premiums.  And the actual increase is likely to be even more than my $17k estimate because the repub plan would allow insurers to charge older folks five times as much as younger folks, rather than the current limit of 3X.  It appears that people like us, who are too old for a catastrophic plan and too young for Medicare, will be the big losers in this scheme.

[fuzzy math]

I have a feeling health insurance will make or break my ability to retire.

I can't even begin to project. How can anyone short of 2 million feel comfortable retiring with all the wild fluctuations floated as plans? It could make a huge difference for most of us.

Personally I think a tad dramatic (though I guess knowing how much your 'base retirement 'stach is changes the equation).
If I were no ACA provisions were in place and I were forced to pay for a non-subsidized, non-employer-sponsored health care plan for my spouse and I it would probably be in the neighborhood of $15k-20k per year with reasonable coverage.  Let's go with the higher number. That's an extra $500k to pay for that in perpetuity, for an absolute worst-case-scenario.

Of course with that much in a "health-care bucket" it would be tempting just to self insure.

My baseline number was probably about $700k with the subsidies. So maybe $2 mil is a bit high, but I was also factoring in having to insure my children for their last couple years of teenage hood, and the possibility that they might add in the lifetime limits again. Even if my higher number isn't reasonable, many decisions here are made based on fear of the worst as opposed to reason, otherwise no one would "one more year" it.

[Iplawyer]

It may depend upon the formula used to calculate the price of your insurance. I don't think that it matters how much you oay, as much as it matters how much the overall premiums are.

In futher research: the Cadillac Tax was originally opposed by republicans because it was indexed to inflation. As premiums rise much, much faster than inflation under the ACA, a larger and larger percentage of Americans would fall under this tax as time went on. Originally Republicans opposed this as they felt middle class Americans should not be subject to this tax. Democrats opposed it because their corporate and union lobby interests opposed it. Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it. Without this the ACA would not be solvent.  So now the answer to a broken Democrat plan based on a Republican plan seems to be an Obama tax that no one wanted to begin with.

So that's where this sits. Obviously the Republican replacement plan is in its infancy and will likely change much as ut moves through the committees, but that is the direction it is heading currently.

You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.

[DavidAnnArbor]

It may depend upon the formula used to calculate the price of your insurance. I don't think that it matters how much you oay, as much as it matters how much the overall premiums are.

In futher research: the Cadillac Tax was originally opposed by republicans because it was indexed to inflation. As premiums rise much, much faster than inflation under the ACA, a larger and larger percentage of Americans would fall under this tax as time went on. Originally Republicans opposed this as they felt middle class Americans should not be subject to this tax. Democrats opposed it because their corporate and union lobby interests opposed it. Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it. Without this the ACA would not be solvent.  So now the answer to a broken Democrat plan based on a Republican plan seems to be an Obama tax that no one wanted to begin with.

So that's where this sits. Obviously the Republican replacement plan is in its infancy and will likely change much as ut moves through the committees, but that is the direction it is heading currently.

You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.

+1

[Bateaux]

I'm still sitting in Limbo waiting out a Republican plan.  I was just meeting my FIRE number this past Fall.  With the loss of the election and promised ACA repeal, I've upped the number an additional 500k.  Using the 4% rule hopefully that covers health insurance and care expenses up to you 20k a year.   If that isn't enough, how will normal people ever retire?  We have to take our country back and pass single payer. 

[Metric Mouse]

Could normal people retire before the ACA? I seem to remember that they did, but I may be mis remebering.

[Metric Mouse]

You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.

Can you point to few sources that shows that Republicans pushed for the excise tax provison and not Obama? I have not come across this in any reading.

The excise tax was not the only source, and of course not the largest source, of funding for ACA.  Just the one of the least popular.

[nereo]

Could normal people retire before the ACA? I seem to remember that they did, but I may be mis remebering.

This is kinda my deduction as well - if things ever get to the point where a majority of the population simply can't afford it the political pressure will force the laws to change. Right now politicians can *almost* ignore healthcare subsidies because most Americans are still on employer-sponsored health care plans, and most of them are blissfully ignorant of how much their employer chips in per month.  Keep the retirees happy by maintaining medicare in some framework (even if its scaled back to kick more young, poor people off) and that could be a sustainable status-quo.

I just don't see how we get to a world where most people have to shell out $20k/year for health insurance. We've grown accustomed to having great medical care at reasonable (to the client) cost.

[bacchi]

Could normal people retire before the ACA? I seem to remember that they did, but I may be mis remebering.

You meant ER, right? They did but most also had government or corporate medical coverage. Retiring from the military put someone in their 40s with VA benefits; many municipalities and states had some "rule of 80" or something, which meant that if you started early enough, you could retire in your early 50s.

I don't know what people like Greaney did. I assume he bought from the market and was healthy enough to do so (i.e., no pre-existing conditions).

[nereo]

Could normal people retire before the ACA? I seem to remember that they did, but I may be mis remebering.

You meant ER, right? They did but most also had government or corporate medical coverage. Retiring from the military put someone in their 40s with VA benefits; many municipalities and states had some "rule of 80" or something, which meant that if you started early enough, you could retire in your early 50s.

I don't know what people like Greaney did. I assume he bought from the market and was healthy enough to do so (i.e., no pre-existing conditions).

Well, Pete retired pre-ACA and that worked out... high deductable family plan and all...
So did Jacob if I recall correctly.

[LadyStache in Baja]

wow, finally finished reading this monster thread. 

Sol, if we can't have single payer, I like your idea. 

Also, why can't we just broaden the congressional health insurance exchange and open it to the whole country and have it paid by the government as if we were all federal employees?

[Metric Mouse]

wow, finally finished reading this monster thread. 

Sol, if we can't have single payer, I like your idea. 

Also, why can't we just broaden the congressional health insurance exchange and open it to the whole country and have it paid by the government as if we were all federal employees?

what if we then just had the government settle the health care bills, without ever sending anything to the citizen? We pay the government our insurance premiums, government pays hospital. Seems to save a step, but it wouldn't make any difference to the people. (Except in the insurance lobby.)

[geekette]

Could normal people retire before the ACA? I seem to remember that they did, but I may be mis remebering.

You meant ER, right? They did but most also had government or corporate medical coverage. Retiring from the military put someone in their 40s with VA benefits; many municipalities and states had some "rule of 80" or something, which meant that if you started early enough, you could retire in your early 50s.

I don't know what people like Greaney did. I assume he bought from the market and was healthy enough to do so (i.e., no pre-existing conditions).

Well, Pete retired pre-ACA and that worked out... high deductable family plan and all...
So did Jacob if I recall correctly.

I have to wonder, though, what these early retirees would have done if they'd been diagnosed with some chronic disease.  Before the ACA, they could have been kicked off, from what I recall, and then be unable to get insurance.  I know I had a friend whose husband was a contractor and while she had insurance, she refused to go to the doctor for fear he'd "find something". 

DH was laid off and decided to retire based on the ACA being available.  If things go back to pre-ACA crap, we're toast. 

[Metric Mouse]

I have to wonder what would happen if an early retiree was in a car wreck, or if they had never gotten a good job in the first place, or if they had a kid with severe disability or had been born in Japan with its stagnant market and been unable to invest in vanguard...

[nereo]

Could normal people retire before the ACA? I seem to remember that they did, but I may be mis remebering.

You meant ER, right? They did but most also had government or corporate medical coverage. Retiring from the military put someone in their 40s with VA benefits; many municipalities and states had some "rule of 80" or something, which meant that if you started early enough, you could retire in your early 50s.

I don't know what people like Greaney did. I assume he bought from the market and was healthy enough to do so (i.e., no pre-existing conditions).

Well, Pete retired pre-ACA and that worked out... high deductable family plan and all...
So did Jacob if I recall correctly.

I have to wonder, though, what these early retirees would have done if they'd been diagnosed with some chronic disease.  Before the ACA, they could have been kicked off, from what I recall, and then be unable to get insurance.  I know I had a friend whose husband was a contractor and while she had insurance, she refused to go to the doctor for fear he'd "find something". 

DH was laid off and decided to retire based on the ACA being available.  If things go back to pre-ACA crap, we're toast.

I think this is wildly misunderstood. Under the pre-ACA system, people who had insurance could not be denied coverage because of some chronic disease.  That would have been illegal (though insurance companies were not against dropping sick individuals like a hot potato if they missed a couple monthly payments). Even back then the fear of not going to the doctor "in case they found something" was unfounded, though many people believed it was true. Under COBRA (passed in 1985), workers were allowed to continue their employer-sponsored health care for 18-36 months by paying into it.

what was legal was denying coverage in the first place for a pre-existing condition. So an otherwise healthy family would have had no problem buying a high deductible plan.  It did limit a chronically sick person from being having access to coverage post-FIRE. 

[gerardc]

I think this is wildly misunderstood. Under the pre-ACA system, people who had insurance could not be denied coverage because of some chronic disease.  That would have been illegal (though insurance companies were not against dropping sick individuals like a hot potato if they missed a couple monthly payments). Even back then the fear of not going to the doctor "in case they found something" was unfounded, though many people believed it was true. Under COBRA (passed in 1985), workers were allowed to continue their employer-sponsored health care for 18-36 months by paying into it.

what was legal was denying coverage in the first place for a pre-existing condition. So an otherwise healthy family would have had no problem buying a high deductible plan.  It did limit a chronically sick person from being having access to coverage post-FIRE.

That's not clear. Were you able to hop from an employer plan to a non-employer plan if you had a chronic disease, after quitting?

[gerardc]

Also, merely making coverage denials illegal has little effect if price increases are not controlled/limited...

[nereo]

I think this is wildly misunderstood. Under the pre-ACA system, people who had insurance could not be denied coverage because of some chronic disease.  That would have been illegal (though insurance companies were not against dropping sick individuals like a hot potato if they missed a couple monthly payments). Even back then the fear of not going to the doctor "in case they found something" was unfounded, though many people believed it was true. Under COBRA (passed in 1985), workers were allowed to continue their employer-sponsored health care for 18-36 months by paying into it.

what was legal was denying coverage in the first place for a pre-existing condition. So an otherwise healthy family would have had no problem buying a high deductible plan.  It did limit a chronically sick person from being having access to coverage post-FIRE.

That's not clear. Were you able to hop from an employer plan to a non-employer plan if you had a chronic disease, after quitting?

No.  If you had a chronic disease you could not hop from one plan to another after quitting - so it was a very bad thing for people who were sick.  But that isn't to say that a healthy family couldn't find insurance. 

Also, merely making coverage denials illegal has little effect if price increases are not controlled/limited...

Again, this is misunderstood. Pre-ACA you couldn't be dropped nor did your premiums skyrocket if they "found something wrong with you".  What it did limit was your ability to change plans post-diagnosis.

As I said earlier, IMO the ACA was a net positive but it's simply false to say that all or even most early retirees could not buy or afford healthcare insurance pre-ACA.  They could, provided they were relatively healthy to begin with, and it was reasonably affordable providing they were willing to shoulder a large (~$5k) annual deductible.
As I said, it was far from perfect, and the IMO the ACA was a net positive.

[sol]

Pre-ACA you couldn't be dropped nor did your premiums skyrocket if they "found something wrong with you". 

Funny, I was dropped from my insurance after I crashed a motorcycle (pre-ACA, in 2006).  There's even a word for it: rescission.  Basically, my insurance company figured it would be cheaper to hire a lawyer to convince a broken and mangled graduate student to not file insurance claims than it would be to pay the $40k in hospital bills from the accident.  They tried to tell me motorcycle accidents weren't covered (they were).  They tried to tell me my coverage had lapsed (it hadn't).  They tried to tell me I didn't really need all those surgeries (I did) and so they weren't going to pay for them.  They tried to tell me physical therapy was only covered for three weeks, not the eight months my doctors recommended (they straight up lied on this one too).

Private for-profit insurance companies have never had any motivation to pay claims.  Any time your claim costs more than the price they think it will cost them to void you claim, you will hear from their lawyers.  Like all capitalist enterprises, their only motive is profit.  They've even identified which demographics are more likely to be persuaded not to repeatedly file claims (students and the elderly) if they just deny them enough times first.  Only relatively stable and determined people have the wherewithal to spend three years fighting with an insurance company to get them to honor their policy, and the insurers know this.

The whole point of the ACA, and insurance regulation in general, is to try to reign in these kinds of abuses. 

[nereo]

Pre-ACA you couldn't be dropped nor did your premiums skyrocket if they "found something wrong with you". 

Funny, I was dropped from my insurance after I crashed a motorcycle (pre-ACA, in 2006).  There's even a word for it: rescission.  Basically, my insurance company figured it would be cheaper to hire a lawyer to convince a broken and mangled graduate student to not file insurance claims than it would be to pay the $40k in hospital bills from the accident.  They tried to tell me motorcycle accidents weren't covered (they were).  They tried to tell me my coverage had lapsed (it hadn't).  They tried to tell me I didn't really need all those surgeries (I did) and so they weren't going to pay for them.  They tried to tell me physical therapy was only covered for three weeks, not the eight months my doctors recommended (they straight up lied on this one too).

Private for-profit insurance companies have never had any motivation to pay claims.  Any time your claim costs more than the price they think it will cost them to void you claim, you will hear from their lawyers.  Like all capitalist enterprises, their only motive is profit.  They've even identified which demographics are more likely to be persuaded not to repeatedly file claims (students and the elderly) if they just deny them enough times first.  Only relatively stable and determined people have the wherewithal to spend three years fighting with an insurance company to get them to honor their policy, and the insurers know this.

The whole point of the ACA, and insurance regulation in general, is to try to reign in these kinds of abuses.

yeah, it was a system rife with abuse, and average Joe (or average Sol?) sometimes had to fight to get the benefits promised because they figured the legal costs were on average far less than the payouts.  See my comment above about being dropped like a "hot potato"  - this happened to a good friend of mine.  This is a core reason why I'm in favor of a highly regulated, limited profit health care system.  Didn't make what happened to you legal - just corporate BS.  At the same time, this was equally bad for people not-yet-employed.  If you got injured and couldn't work the same thing happened to you.

My point was simply that, pre-ACA, early retirees who were otherwise healthy were able to afford health care.  Most of the time it worked out fine, some of the time you'd have to spend an asinine amount of time getting the private insurers to pay up.  Which is why I am deeply skeptical of any "solution" which relies on private insurance companies and "free-market forces" to make it work. What's best for the company is typically to the detriment of the individual filing the claim.

[Iplawyer]

You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.

Can you point to few sources that shows that Republicans pushed for the excise tax provison and not Obama? I have not come across this in any reading.

The excise tax was not the only source, and of course not the largest source, of funding for ACA.  Just the one of the least popular.

Quote from: Metric Mouse on February 25, 2017, 12:47:24 PM
It may depend upon the formula used to calculate the price of your insurance. I don't think that it matters how much you oay, as much as it matters how much the overall premiums are.

In futher research: the Cadillac Tax was originally opposed by republicans because it was indexed to inflation. As premiums rise much, much faster than inflation under the ACA, a larger and larger percentage of Americans would fall under this tax as time went on. Originally Republicans opposed this as they felt middle class Americans should not be subject to this tax. Democrats opposed it because their corporate and union lobby interests opposed it. Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it. Without this the ACA would not be solvent.  So now the answer to a broken Democrat plan based on a Republican plan seems to be an Obama tax that no one wanted to begin with.

So that's where this sits. Obviously the Republican replacement plan is in its infancy and will likely change much as ut moves through the committees, but that is the direction it is heading currently.
You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.

Metric Mouse - to quote one of your lies directly "Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it."  And you went on to lie again " Without this the ACA would not be solvent." Please, please, please - after spouting these outright lies - go do your own research on the truth.  And all of the replacement plans from each of the Republican factions plan to do more of the same or go further.  If you are interested in reading about the truth of the issue - this story talks about why the Republicans want it now even more so:
https://www.nytimes.com/2017/02/17/upshot/to-fund-health-plan-gop-considers-limiting-popular-tax-break.html

[BTDretire]

Won't there then be a return to the old 'catastrophic only policies' with high deductibles that MMM used on his FIRE?

 I like my "old 'catastrophic only policies' with high deductibles", the premium is about 1/2 of an ACA policy.
The only problem, I'm still paying for subsidies and for all the people that qualified for medicare since the ACA started.
 I'm paying an $8,800 premium and a $10,000 deductible and max OOP. Plus I get a deduction for my HSA contribution.
  I think a certain amount of deductible is desirable to eliminate nuisance doctor appointments. Maybe 6% to 8% of gross income possibly reduced slightly for lower incomes. People need to have skin in the game to help reduce costs.

Fortunately it looks increasingly as if the GOP like being re-elected even more than they like gutting social safety nets, so the changes may be small enough to just be able to claim with a straight face (and a lot of spin) that Trump/Ryancare is huuuuugely improved on that old Obamacare disaster and there, I fixed it. It's now great (if suspiciously the same as it was before). Afterall it was always essentially a republican right wing conservative plan.

The big hit will depend on (a)which State you're in and (b)if you are so poor you're dependant on Medicare.

It can't be as it was before, it was failing, and getting worse as time went on. More and more insurance companies were pulling out and the premiums were going higher and higher.

[waltworks]

Given ~15% inflation in healthcare costs over the last decade or so, a current plan would be expected to cost about 4x what the same thing cost in 2007.

Just for reference. I don't know that the 15% number is exactly right but if you're upset that you're paying now than you were 10 years ago... well, you would be regardless. Prices have been rising like made for 20-25 years.

-W

[AdrianC]

If I read the article about the republican plan correctly, the most DW and I could get would be $8k in tax credits (probably less), which would not cover my projected $17k increase in premiums.  And the actual increase is likely to be even more than my $17k estimate because the repub plan would allow insurers to charge older folks five times as much as younger folks, rather than the current limit of 3X.  It appears that people like us, who are too old for a catastrophic plan and too young for Medicare, will be the big losers in this scheme.

Too old for a catastrophic plan? Under the ACA, yes. Under the proposed system I don't know. I've read R proposals bringing back catastrophic plans but don't think ages were mentioned.

They are certainly hung ho for high deductible plans for everyone.

[geekette]

If I read the article about the republican plan correctly, the most DW and I could get would be $8k in tax credits (probably less), which would not cover my projected $17k increase in premiums.  And the actual increase is likely to be even more than my $17k estimate because the repub plan would allow insurers to charge older folks five times as much as younger folks, rather than the current limit of 3X.  It appears that people like us, who are too old for a catastrophic plan and too young for Medicare, will be the big losers in this scheme.

Too old for a catastrophic plan? Under the ACA, yes. Under the proposed system I don't know. I've read R proposals bringing back catastrophic plans but don't think ages were mentioned.

They are certainly hung ho for high deductible plans for everyone.

And yet yesterday I saw a video of Trump supporters (I think it was in KY) who have benefited from the ACA saying that plans with $2000 deductible are just too high.  They aren't gonna like the new stuff any better.

[Metric Mouse]

https://www.nytimes.com/2017/02/17/upshot/to-fund-health-plan-gop-considers-limiting-popular-tax-break.html

You didn't answer the question. Your source backs up my claim that the republicans are using this idea that they originally opposed.

[AdrianC]

And yet yesterday I saw a video of Trump supporters (I think it was in KY) who have benefited from the ACA saying that plans with $2000 deductible are just too high.  They aren't gonna like the new stuff any better.

No doubt. High deductibles are the Republican dream.

Trump told them he was going to replace Obamacare with something "fantastic". They believe him. I have no answer.

[Metric Mouse]

And yet yesterday I saw a video of Trump supporters (I think it was in KY) who have benefited from the ACA saying that plans with $2000 deductible are just too high.  They aren't gonna like the new stuff any better.

No doubt. High deductibles are the Republican dream.

Trump told them he was going to replace Obamacare with something "fantastic". They believe him. I have no answer.

Neither did Republicans... but they are almost working on it...