Author Topic: What comes after the ACA?  (Read 821622 times)

keyvaluepair

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Re: What comes after the ACA?
« Reply #3850 on: November 06, 2017, 08:28:03 AM »
So LMK if I got this right?
(1) FPL for a family of 3 is 20420.
(2) CHIP eligibility for WA is 210% of FPL  = 42882
(3) Medicaid eligibility is 138% of FPL = 33,948
(4) So our AGI has to be between $42,882 to 81680 to be eligible for the tax credit and not have to deal with paying full rates.

Is that correct?

jim555

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Re: What comes after the ACA?
« Reply #3851 on: November 06, 2017, 08:38:45 AM »
My FPL numbers don't agree with yours.  I see family of 3 at $28,180 (138% FPL).  If that is true then 210% FPL would be $42,882.
So you need over $42,882 to avoid CHIP and under $81,680 to be under 400% FPL (subsidy land).


keyvaluepair

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Re: What comes after the ACA?
« Reply #3852 on: November 06, 2017, 09:17:40 AM »
@Jim55. You are right, I had an off-by-one error when reading the table for the 138% of FPL. But yes, still between $42882 and 81680 is the magic target.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3853 on: November 06, 2017, 09:27:16 AM »
Here's a show about ACA enrollment that is on right now live for the next 30 minutes.

http://www.wbur.org/onpoint/2017/11/05/obamacare-open-enrollment

EnjoyIt

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Re: What comes after the ACA?
« Reply #3854 on: November 06, 2017, 11:38:23 PM »
EnjoyIt:

https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem

Check it out!  I think this is a good article. I don't totally agree that the ACA has no price control measures (bundling, for example, is a price control measure), but I do agree that bringing prices down was not a goal of the ACA and is a crucial fundamental next step.

My blood was absolutely boiling reading about that 25k MRI.  The hospital response was 100% nonsense.  Plus, the hospital had to know that its price was out of whack with the vast majority of reimbursement rates, and they did not inform the patient ahead of time.  I'd love to see a database of procedure average prices at each hospital.  If Stanford wants to charge 25k for an MRI, they can probably fill all their slots with rich foreign patients, but at least US patients can be warned.

Thanks for the link.  $25k for an MRI is ludicrous.  Even $7k for the same MRI elsewhere is crazy.  This family is better off going out of the country on vacation and getting the MRI there and still spending less. But, lets keep watching our politicians and media pundits continue to argue about who will pay for the MRI.  I almost think that all this bickering is engineered smoke and mirrors to keep us debating the wrong subject while the healthcare industry keep raking in those profits.

I think having mandatory transparency would be a good first step in curbing costs.  Patients need to know how much these outpatient studies will cost and the price should be exactly the same no matter what insurance the patient may or may not have.

wenchsenior

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Re: What comes after the ACA?
« Reply #3855 on: November 07, 2017, 06:44:24 AM »
EnjoyIt:

https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem

Check it out!  I think this is a good article. I don't totally agree that the ACA has no price control measures (bundling, for example, is a price control measure), but I do agree that bringing prices down was not a goal of the ACA and is a crucial fundamental next step.

My blood was absolutely boiling reading about that 25k MRI.  The hospital response was 100% nonsense.  Plus, the hospital had to know that its price was out of whack with the vast majority of reimbursement rates, and they did not inform the patient ahead of time.  I'd love to see a database of procedure average prices at each hospital.  If Stanford wants to charge 25k for an MRI, they can probably fill all their slots with rich foreign patients, but at least US patients can be warned.

Thanks for the link.  $25k for an MRI is ludicrous.  Even $7k for the same MRI elsewhere is crazy.  This family is better off going out of the country on vacation and getting the MRI there and still spending less. But, lets keep watching our politicians and media pundits continue to argue about who will pay for the MRI.  I almost think that all this bickering is engineered smoke and mirrors to keep us debating the wrong subject while the healthcare industry keep raking in those profits.

I think having mandatory transparency would be a good first step in curbing costs.  Patients need to know how much these outpatient studies will cost and the price should be exactly the same no matter what insurance the patient may or may not have.

MRIs are just ridiculous.  I have them routinely every few years, and my husband just had one on his knee.  So we've racked up at least 100K in MRI bills for our insurance company (and thousands for our part of the bills)...and that's just diagnostics!  Whenever I'm in the machine, I like to imagine every rotation costs 500$.

Optimiser

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Re: What comes after the ACA?
« Reply #3856 on: November 07, 2017, 08:07:37 AM »
I hate the way the current system is structured so much. I just figured out it is going to cost $630/month to insure my wife and 3 kids; I am covered by "free" insurance through my work. That is 17% of my gross paycheck, but we don't qualify for subsidies because we have the option to purchase insurance through my employer for even more money.

wenchsenior

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Re: What comes after the ACA?
« Reply #3857 on: November 07, 2017, 08:44:40 AM »
I hate the way the current system is structured so much. I just figured out it is going to cost $630/month to insure my wife and 3 kids; I am covered by "free" insurance through my work. That is 17% of my gross paycheck, but we don't qualify for subsidies because we have the option to purchase insurance through my employer for even more money.

Huh...that doesn't seem that bad to me at all.   It costs us about 430$/month to insure 2 adults on federal health insurance.  So you are getting a much better deal than us. Unless your deductible is very high? (We don't have a deductible on our plan).

Optimiser

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Re: What comes after the ACA?
« Reply #3858 on: November 07, 2017, 10:42:55 AM »
I hate the way the current system is structured so much. I just figured out it is going to cost $630/month to insure my wife and 3 kids; I am covered by "free" insurance through my work. That is 17% of my gross paycheck, but we don't qualify for subsidies because we have the option to purchase insurance through my employer for even more money.

Huh...that doesn't seem that bad to me at all.   It costs us about 430$/month to insure 2 adults on federal health insurance.  So you are getting a much better deal than us. Unless your deductible is very high? (We don't have a deductible on our plan).

Calendar year deductible is $5,000, out of pocket maximum is $6,350. Oh, and I only have 2 kids, not sure why I said 3 earlier.

sol

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Re: What comes after the ACA?
« Reply #3859 on: November 07, 2017, 10:48:36 AM »
I'm frankly a little bit disgusted by the new MMM main blog post about the ACA.

Yes, your rates went up a lot this year because you make over $400k per yea, too much to qualify for subsidies, and the unsubsidized rates went up due to republican sabotage of the insurance markets.  But that same sabotage that raised rates for the MMM family inadvertently raised the subsidy rates for people under the 400% FPL, making their insurance more affordable.

Liberals should be celebrating the republican interference in the insurance markets.  Hooray!  They made rich people pay more and lowered rates for everyone else!  This is exactly what the market needs to stay healthy.

He even said it himself, he makes so much money he won't really notice the rate increase.  I think he should change that blog post to be more celebratory and less whiny.  What's best for society here, vs what's best for Pete personally? Is this a blog about saving the world, or about making Pete rich?

What's next, MMM complains about the estate tax exemption being too low so his son might actually have to get a job someday instead of just living off the MMM fortune?

Exflyboy

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Re: What comes after the ACA?
« Reply #3860 on: November 07, 2017, 11:06:41 AM »
Fair point Sol,

One of the dangers of any leader is to become so successful that you separate yourself from the troops in the trenches.. Thinking back to a WW1 example where the general is sitting on his horse looking fine and splendid and making a motivational speech to the English tommy's are about to march in to mud guts and filth to their deaths while mr general sips tea from a china cup back at HQ.

So Pete has "rich people" problems but the average MMM reader has a pile of debt and wants to FIRE one day.. Hard to relate no?

Then again, Pete is a very down to Earth guy and I guess we all work our issues from where we are at, I know I do it but then I don't own a blog that is trying to motivate people either..

sol

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Re: What comes after the ACA?
« Reply #3861 on: November 07, 2017, 11:29:15 AM »
It pains me to be critical, in this instance.  His pain is real, and born of the same desire to optimize that helped him reach his current lofty perch.  It is the pain of all rich people who want to be even richer, and let the peasants eat cake.

And the blog has been truly motivational to thousands of people, and undoubtedly a force for good in the world.  This particular post, though, I think is a serious misstep. It seems antithetical to everything MMM was about.

Wait, is it April first already?

brooklynguy

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Re: What comes after the ACA?
« Reply #3862 on: November 07, 2017, 11:51:37 AM »
Yes, your rates went up a lot this year because you make over $400k per yea, too much to qualify for subsidies, and the unsubsidized rates went up due to republican sabotage of the insurance markets.  But that same sabotage that raised rates for the MMM family inadvertently raised the subsidy rates for people under the 400% FPL, making their insurance more affordable.

Liberals should be celebrating the republican interference in the insurance markets.  Hooray!  They made rich people pay more and lowered rates for everyone else!  This is exactly what the market needs to stay healthy.

But the specific consequences of the republican interference are highly state-dependent.  As you know, many (mostly blue) states' insurance regulators responded to the threat of elimination of CSR payments with creative solutions that effectively benefitted most subsidized enrollees (and at the same time minimized or eliminated any adverse impact on unsubsidized enrollees), but that didn't happen in Colorado.  There, insurers loaded the costs of termination of CSR reimbursement equally across all plans, which had the effect of increasing costs for subsidized enrollees in gold and platinum plans (i.e., the portion of the risk pool where the sickest low-income enrollees are concentrated) in addition to all unsubsidized enrollees like Pete (see here for details).

DTaggart

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Re: What comes after the ACA?
« Reply #3863 on: November 07, 2017, 12:03:41 PM »
I'm frankly a little bit disgusted by the new MMM main blog post about the ACA.

Yes, your rates went up a lot this year because you make over $400k per yea, too much to qualify for subsidies, and the unsubsidized rates went up due to republican sabotage of the insurance markets.  But that same sabotage that raised rates for the MMM family inadvertently raised the subsidy rates for people under the 400% FPL, making their insurance more affordable.

Liberals should be celebrating the republican interference in the insurance markets.  Hooray!  They made rich people pay more and lowered rates for everyone else!  This is exactly what the market needs to stay healthy.

He even said it himself, he makes so much money he won't really notice the rate increase.  I think he should change that blog post to be more celebratory and less whiny.  What's best for society here, vs what's best for Pete personally? Is this a blog about saving the world, or about making Pete rich?

What's next, MMM complains about the estate tax exemption being too low so his son might actually have to get a job someday instead of just living off the MMM fortune?

I had the same reaction when I read his post, but I sort of think he was *trying* to address the issue from the point of view of a "normal" Mustachian who isn't making 400k/year. I mean, the ACA changes will have a significant impact on many of his readers, so he felt the need to address it. He couldn't just say "Well I make $400k/year so I'll just pay the increase and NBD," because his followers and the naysaysers would be like "Well sure it's easy for you but what about the REST of us mere mortals? Mustachianism just doesn't work." So he had to layout some of the other alternatives and ended up going a little too stream-of-consciousness. He could have done this one a lot better.

wenchsenior

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Re: What comes after the ACA?
« Reply #3864 on: November 07, 2017, 12:27:22 PM »
I hate the way the current system is structured so much. I just figured out it is going to cost $630/month to insure my wife and 3 kids; I am covered by "free" insurance through my work. That is 17% of my gross paycheck, but we don't qualify for subsidies because we have the option to purchase insurance through my employer for even more money.

Huh...that doesn't seem that bad to me at all.   It costs us about 430$/month to insure 2 adults on federal health insurance.  So you are getting a much better deal than us. Unless your deductible is very high? (We don't have a deductible on our plan).

Calendar year deductible is $5,000, out of pocket maximum is $6,350. Oh, and I only have 2 kids, not sure why I said 3 earlier.


Ah, yes, that ends up working out to ~150/person more than we pay.  It is interesting that I don't really feel I have any idea what a  'reasonable' amount to charge for insurance should be.  I'm used to paying what we pay, and having it go up every year, and it probably seems normal just because I'm  used to it.  I have no idea if it is objectively reasonable or not.

Optimiser

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Re: What comes after the ACA?
« Reply #3865 on: November 07, 2017, 01:12:17 PM »
I hate the way the current system is structured so much. I just figured out it is going to cost $630/month to insure my wife and 3 kids; I am covered by "free" insurance through my work. That is 17% of my gross paycheck, but we don't qualify for subsidies because we have the option to purchase insurance through my employer for even more money.

Huh...that doesn't seem that bad to me at all.   It costs us about 430$/month to insure 2 adults on federal health insurance.  So you are getting a much better deal than us. Unless your deductible is very high? (We don't have a deductible on our plan).

Calendar year deductible is $5,000, out of pocket maximum is $6,350. Oh, and I only have 2 kids, not sure why I said 3 earlier.


Ah, yes, that ends up working out to ~150/person more than we pay.  It is interesting that I don't really feel I have any idea what a  'reasonable' amount to charge for insurance should be.  I'm used to paying what we pay, and having it go up every year, and it probably seems normal just because I'm  used to it.  I have no idea if it is objectively reasonable or not.

I don't either. But if I include what my employer pays for my health insurance, my family pays more for insurance than we do for food, or housing, or transportation, or taxes, and that seems unreasonable.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #3866 on: November 07, 2017, 01:19:27 PM »

Ah, yes, that ends up working out to ~150/person more than we pay.  It is interesting that I don't really feel I have any idea what a  'reasonable' amount to charge for insurance should be.  I'm used to paying what we pay, and having it go up every year, and it probably seems normal just because I'm  used to it.  I have no idea if it is objectively reasonable or not.

This is something I've been wrestling with a little bit.

We seem to just be resigned to paying more every year for less. My employer keeps jacking up the emergency room copays, it was $50 when I started six years ago, now it's $150, and I think next year it's like $200. Thankfully we didn't have any ER visits this year, but it's not like we haven't in the past.

I understand ER visits are expensive, but when the urgent care tries to turf us to the ER because my kid bumped his head, that's not helping anyone. Although going up to the same desk an hour later for our same-day pediatrics appointment was a little funny.

wenchsenior

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Re: What comes after the ACA?
« Reply #3867 on: November 07, 2017, 01:31:29 PM »
I hate the way the current system is structured so much. I just figured out it is going to cost $630/month to insure my wife and 3 kids; I am covered by "free" insurance through my work. That is 17% of my gross paycheck, but we don't qualify for subsidies because we have the option to purchase insurance through my employer for even more money.

Huh...that doesn't seem that bad to me at all.   It costs us about 430$/month to insure 2 adults on federal health insurance.  So you are getting a much better deal than us. Unless your deductible is very high? (We don't have a deductible on our plan).

Calendar year deductible is $5,000, out of pocket maximum is $6,350. Oh, and I only have 2 kids, not sure why I said 3 earlier.


Ah, yes, that ends up working out to ~150/person more than we pay.  It is interesting that I don't really feel I have any idea what a  'reasonable' amount to charge for insurance should be.  I'm used to paying what we pay, and having it go up every year, and it probably seems normal just because I'm  used to it.  I have no idea if it is objectively reasonable or not.

I don't either. But if I include what my employer pays for my health insurance, my family pays more for insurance than we do for food, or housing, or transportation, or taxes, and that seems unreasonable.

Good point. For 2 people, total insurance costs including the employer part is about 4K/year MORE than we pay for mortgage/insurance/property tax on TWO houses.  That does seem pretty crazy.

waltworks

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Re: What comes after the ACA?
« Reply #3868 on: November 07, 2017, 01:46:53 PM »
Without excusing any of the inefficiencies/stupidities/cruelties of the current system, which are legion - it's at least to some extent a *good* thing that we're paying more for healthcare, because there's more useful healthcare out there to buy.

In 1800, you were probably better off *not* going to the doctor if you were ill. Even if you did, the services and drugs/procedures available were pretty lousy. Contrast that with today when you can have your own immune cells modified to cure (literally, cure) a number of blood-born cancers, and you can have your hip replaced and run marathons again, and you're very unlikely to die of an infection or burst appendix or other minor but deadly problem.

There's more to buy! And it's stuff we mostly *want* (yes, of course there are stupid drugs whose side effects are worse than the condition they're treating, too). If I could pay most of my net worth to, say, extend my healthy life by a decade, you're darn right I'd do it.

So I'm sort of fundamentally ok with healthcare taking up more and more of our GDP. It's probably the  most worthwhile thing to spend money on, assuming you've made sure you have food/housing. Hell, I'd rather have my health and no house than be sick in live in a mansion, so maybe it's second only to adequate food and water?

I'm rambling. The system is set up idiotically and inefficiently. But we're also getting a lot more utility out of it than we did in the past, so it's not all bad.

-W

NoStacheOhio

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Re: What comes after the ACA?
« Reply #3869 on: November 07, 2017, 01:59:31 PM »
If I could pay most of my net worth to, say, extend my healthy life by a decade, you're darn right I'd do it.

That's not usually the trade-off you're making though. Cancer being the most obvious example.

A young cancer patient will consume a huge amount of care without extending their life expectancy compared to the average for their general demographics.

waltworks

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Re: What comes after the ACA?
« Reply #3870 on: November 07, 2017, 02:08:08 PM »
That's not usually the trade-off you're making though. Cancer being the most obvious example.

A young cancer patient will consume a huge amount of care without extending their life expectancy compared to the average for their general demographics.

Um, what? You mean they won't live longer than someone who doesn't get cancer?

I'm failing to see your point. We're not comparing this cancer patient to a healthy person, we're comparing them to someone else who doesn't get treatment and dies.

I don't think I understand what you're trying to say. My point was that treatments have become more and more effective, and numerous, and that means that stuff that used to kill you doesn't. That costs money, but spending money to not die is something most of us are happy to do.

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mm1970

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Re: What comes after the ACA?
« Reply #3871 on: November 07, 2017, 04:21:04 PM »
If I could pay most of my net worth to, say, extend my healthy life by a decade, you're darn right I'd do it.

That's not usually the trade-off you're making though. Cancer being the most obvious example.

A young cancer patient will consume a huge amount of care without extending their life expectancy compared to the average for their general demographics.
But...that means my friend whose kid just went thru cancer treatments last year will probably live to be 80, instead of dying at age 4.

jim555

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Re: What comes after the ACA?
« Reply #3872 on: November 07, 2017, 07:09:45 PM »
Looks like Maine will get the Medicaid expansion!

maizeman

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Re: What comes after the ACA?
« Reply #3873 on: November 07, 2017, 08:19:55 PM »
That costs money, but spending money to not die is something most of us are happy to do.

Yup. I'd prefer to spend the least money possible to A) not die and B) avoid pain, illness, or disability, but in the end, I'd much rather pay the money than accept the alternative.

In the most recent MMM post he calculates each person consumes an average of $5,600/year in healthcare, but he doesn't seem to take into account that his premium is for three people, not one. So his family would be expected to consume $16,800/year in healthcare, which is still a bit less than the annual premium + maxing the deductible each year. However, if you figure some years you don't need any care at all and others you end up with mid-five-figure medical bills, I think it comes out about even.* Am I misunderstanding something about the example?

*Obviously this doesn't take into account that the elderly who have the highest healthcare bills are covered by medicare.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3874 on: November 07, 2017, 09:08:00 PM »
That costs money, but spending money to not die is something most of us are happy to do.

Yup. I'd prefer to spend the least money possible to A) not die and B) avoid pain, illness, or disability, but in the end, I'd much rather pay the money than accept the alternative.

In the most recent MMM post he calculates each person consumes an average of $5,600/year in healthcare, but he doesn't seem to take into account that his premium is for three people, not one. So his family would be expected to consume $16,800/year in healthcare, which is still a bit less than the annual premium + maxing the deductible each year. However, if you figure some years you don't need any care at all and others you end up with mid-five-figure medical bills, I think it comes out about even.* Am I misunderstanding something about the example?

*Obviously this doesn't take into account that the elderly who have the highest healthcare bills are covered by medicare.

Also, in a 'Matrix' movie-like twist, MMM's annual healthcare is low because he apparently lives a low stress, low risk ER life.  He is outside the Matrix and does not want to be burdened by paying for others inside the Matrix commuting to jobs to provide that lumber for his home building hobby, farmed food for his family, or ultimately the stock market returns that allow him to live off passive income. 

Either you complain that people should all be retired and make it their full time job to take care of themselves (and have no health insurance system) or you suck it up and pay what the system needs in order for the whole thing to keep on working.  It's not just the Mustache family that opened up their mail and said 'Fuck fuck fuck', but in some cases, those people really are fucked.

JLee

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Re: What comes after the ACA?
« Reply #3875 on: November 07, 2017, 09:41:57 PM »
That costs money, but spending money to not die is something most of us are happy to do.

Yup. I'd prefer to spend the least money possible to A) not die and B) avoid pain, illness, or disability, but in the end, I'd much rather pay the money than accept the alternative.

In the most recent MMM post he calculates each person consumes an average of $5,600/year in healthcare, but he doesn't seem to take into account that his premium is for three people, not one. So his family would be expected to consume $16,800/year in healthcare, which is still a bit less than the annual premium + maxing the deductible each year. However, if you figure some years you don't need any care at all and others you end up with mid-five-figure medical bills, I think it comes out about even.* Am I misunderstanding something about the example?

*Obviously this doesn't take into account that the elderly who have the highest healthcare bills are covered by medicare.

Also, in a 'Matrix' movie-like twist, MMM's annual healthcare is low because he apparently lives a low stress, low risk ER life.  He is outside the Matrix and does not want to be burdened by paying for others inside the Matrix commuting to jobs to provide that lumber for his home building hobby, farmed food for his family, or ultimately the stock market returns that allow him to live off passive income. 

Either you complain that people should all be retired and make it their full time job to take care of themselves (and have no health insurance system) or you suck it up and pay what the system needs in order for the whole thing to keep on working.  It's not just the Mustache family that opened up their mail and said 'Fuck fuck fuck', but in some cases, those people really are fucked.

How exactly do you draw this conclusion?

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3876 on: November 07, 2017, 10:33:30 PM »
That costs money, but spending money to not die is something most of us are happy to do.

Yup. I'd prefer to spend the least money possible to A) not die and B) avoid pain, illness, or disability, but in the end, I'd much rather pay the money than accept the alternative.

In the most recent MMM post he calculates each person consumes an average of $5,600/year in healthcare, but he doesn't seem to take into account that his premium is for three people, not one. So his family would be expected to consume $16,800/year in healthcare, which is still a bit less than the annual premium + maxing the deductible each year. However, if you figure some years you don't need any care at all and others you end up with mid-five-figure medical bills, I think it comes out about even.* Am I misunderstanding something about the example?

*Obviously this doesn't take into account that the elderly who have the highest healthcare bills are covered by medicare.

Also, in a 'Matrix' movie-like twist, MMM's annual healthcare is low because he apparently lives a low stress, low risk ER life.  He is outside the Matrix and does not want to be burdened by paying for others inside the Matrix commuting to jobs to provide that lumber for his home building hobby, farmed food for his family, or ultimately the stock market returns that allow him to live off passive income. 

Either you complain that people should all be retired and make it their full time job to take care of themselves (and have no health insurance system) or you suck it up and pay what the system needs in order for the whole thing to keep on working.  It's not just the Mustache family that opened up their mail and said 'Fuck fuck fuck', but in some cases, those people really are fucked.

How exactly do you draw this conclusion?

I PM'ed JLee and he wondered how I draw this conclusion.  I wanted to leave it a little open-ended, but it's simply extrapolating from recent history.  People who need a government subsidy are seeing it stripped away unless they truly have nothing and this health insurance saves them from dying in the street.  And us FI-ER folks are unable to beat the system, but maybe it's because we are breaking the system.

JLee

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Re: What comes after the ACA?
« Reply #3877 on: November 07, 2017, 10:38:09 PM »
That costs money, but spending money to not die is something most of us are happy to do.

Yup. I'd prefer to spend the least money possible to A) not die and B) avoid pain, illness, or disability, but in the end, I'd much rather pay the money than accept the alternative.

In the most recent MMM post he calculates each person consumes an average of $5,600/year in healthcare, but he doesn't seem to take into account that his premium is for three people, not one. So his family would be expected to consume $16,800/year in healthcare, which is still a bit less than the annual premium + maxing the deductible each year. However, if you figure some years you don't need any care at all and others you end up with mid-five-figure medical bills, I think it comes out about even.* Am I misunderstanding something about the example?

*Obviously this doesn't take into account that the elderly who have the highest healthcare bills are covered by medicare.

Also, in a 'Matrix' movie-like twist, MMM's annual healthcare is low because he apparently lives a low stress, low risk ER life.  He is outside the Matrix and does not want to be burdened by paying for others inside the Matrix commuting to jobs to provide that lumber for his home building hobby, farmed food for his family, or ultimately the stock market returns that allow him to live off passive income. 

Either you complain that people should all be retired and make it their full time job to take care of themselves (and have no health insurance system) or you suck it up and pay what the system needs in order for the whole thing to keep on working.  It's not just the Mustache family that opened up their mail and said 'Fuck fuck fuck', but in some cases, those people really are fucked.

How exactly do you draw this conclusion?

I PM'ed JLee and he wondered how I draw this conclusion.  I wanted to leave it a little open-ended, but it's simply extrapolating from recent history.  People who need a government subsidy are seeing it stripped away unless they truly have nothing and this health insurance saves them from dying in the street.  And us FI-ER folks are unable to beat the system, but maybe it's because we are breaking the system.

The system is already broken by the companies who are earning countless billions in profits off of the health care industry.

Exflyboy

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Re: What comes after the ACA?
« Reply #3878 on: November 07, 2017, 11:24:25 PM »
Well exactly,

The healthcare industry is about 15% of the US economy. So if you own VTSAX or total market index funds take 15% of your dividends and capital gains (of course not all sectors rise equally) and thats roughly what you dear investor are earning from our broken HC system.

I mean do any of us with significant wealth really want the system to change?

I saw this with tongue firmly in cheek.. I would happily reduce my NW by say 10% and have everybody in the US have access to universal HC for 1/3rd to half the cost.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #3879 on: November 08, 2017, 06:14:45 AM »
That's not usually the trade-off you're making though. Cancer being the most obvious example.

A young cancer patient will consume a huge amount of care without extending their life expectancy compared to the average for their general demographics.

Um, what? You mean they won't live longer than someone who doesn't get cancer?

I'm failing to see your point. We're not comparing this cancer patient to a healthy person, we're comparing them to someone else who doesn't get treatment and dies.

I don't think I understand what you're trying to say. My point was that treatments have become more and more effective, and numerous, and that means that stuff that used to kill you doesn't. That costs money, but spending money to not die is something most of us are happy to do.

-W

Basically, yes. We're paying huge sums of money to live the same (or less) than our healthy peers. Maybe it's semantic, but the way you worded it in your first post made it sound like we're looking at buying healthy life absent a serious illness.

I'm not at all saying we shouldn't spend that money--my own insurance company spent the money this year, and continues to spend the money.

EnjoyIt

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Re: What comes after the ACA?
« Reply #3880 on: November 08, 2017, 07:46:44 PM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

JLee

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Re: What comes after the ACA?
« Reply #3881 on: November 08, 2017, 07:55:09 PM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

My portion of my employer-provided health insurance has more than doubled in two years. Fortunately it's still exceptionally affordable, but still - there's definitely a trend going on..

EnjoyIt

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Re: What comes after the ACA?
« Reply #3882 on: November 08, 2017, 08:12:50 PM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

My portion of my employer-provided health insurance has more than doubled in two years. Fortunately it's still exceptionally affordable, but still - there's definitely a trend going on..

Those who pay for health insurance have had to pay more over the years.  Cost has been increasing faster than inflation way before the ACA was even a thought as well as after Trump took office.  The trend is there but I think it may be decades long. And BTW, ACA took affect in 2011


JLee

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Re: What comes after the ACA?
« Reply #3883 on: November 08, 2017, 08:26:01 PM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

My portion of my employer-provided health insurance has more than doubled in two years. Fortunately it's still exceptionally affordable, but still - there's definitely a trend going on..

Those who pay for health insurance have had to pay more over the years.  Cost has been increasing faster than inflation way before the ACA was even a thought as well as after Trump took office.  The trend is there but I think it may be decades long. And BTW, ACA took affect in 2011



Yep, I believe it.  It's been going on for a long time, but getting hit on the employer side here is new ($13/check when I was hired, $27/check now - still ridiculously cheap, but costs can't have been increasing at this rate all that long, given how low it was when I was hired).

On the bright side, they upped our 401k match. :)

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3884 on: November 09, 2017, 04:05:03 AM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

I think it's already been discussed ad infinitum in this thread, but a large part of the 2018 premium increases are because insurers are recouping the cost sharing payments that Trump cancelled.  There is no real debate on this point.  The insurers are obligated to give the cost sharing reductions to the insured, but the government no longer reimburses the insurers.  So they raised premiums to compensate.  Here's an example news story; I'm sure there are many others out there:

http://money.cnn.com/2017/10/26/news/economy/obamacare-premiums-open-enrollment/index.html

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3885 on: November 09, 2017, 06:04:20 AM »
Here's a dramatic story of saving a boy's life due to advances in medicine.

Gene Therapy Creates Replacement Skin to Save a Dying Boy
https://nyti.ms/2jbAQ4W

use2betrix

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Re: What comes after the ACA?
« Reply #3886 on: November 09, 2017, 09:57:53 AM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

My portion of my employer-provided health insurance has more than doubled in two years. Fortunately it's still exceptionally affordable, but still - there's definitely a trend going on..

Those who pay for health insurance have had to pay more over the years.  Cost has been increasing faster than inflation way before the ACA was even a thought as well as after Trump took office.  The trend is there but I think it may be decades long. And BTW, ACA took affect in 2011



And on the other hand, before ACA there were actually much better plans available that you canít even purchase now.

Before the ACA I could purchase a PPO plan that would allow me to have coverage nationwide with a huge list of providers. In Texas (and with most state) all you can now buy is these shi**y HMO plans with incredibly small networks. I have no coverage other than life threatening emergency illness, outside my small home network area.

People that travel frequently around the country got majorly screwed. (Myself)

But, alas, more people have coverage, even though those with higher incomes are the ones paying for it, all while receiving worse coverage. This ACA has been nothing more than another re-distribution of wealth. Notice the proponents of the ACA frequently only focus on the number of those insured. Quantity over quality.

They should start providing tax deductions for those with healthy diets who exercise regularly, etc  so much of these healthcare costs are due to preventable conditions (obesity, etc.). For whatever reason, smoking is the only thing they care about, even though obesity related conditions are now the leading cause of preventable illness.

jorjor

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Re: What comes after the ACA?
« Reply #3887 on: November 09, 2017, 10:12:36 AM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

As Monkey Uncle said, the increase is due to CSR payments being removed. Kaiser Family Foundation has put a range on that surcharge: https://www.kff.org/health-reform/issue-brief/how-the-loss-of-cost-sharing-subsidy-payments-is-affecting-2018-premiums/

Now, many states allowed carriers to file rates assuming those CSR payments would be removed, or at least file two sets of rates (one with and without removal) in the anticipation that they would be removed. That's likely where the idea that rate increases are due to threat/fear of Republican interference. There might be some built in buffer for the removal of an individual mandate, but the CSR deal is the big one.
« Last Edit: November 09, 2017, 01:05:03 PM by jorjor »

GettingClose

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Re: What comes after the ACA?
« Reply #3888 on: November 09, 2017, 10:22:32 AM »
Quote
And on the other hand, before ACA there were actually much better plans available that you canít even purchase now.

Better in some ways.  While having lower premiums and lower deductibles they almost all:
* had lifetime caps on coverage
* had no out-of-pocket maximums.  For example, there was no point when you didn't pay your 20% of an 80/20 plan
* didn't allow pre-existing conditions (and this was tightly defined - I had a child denied coverage for acne)
* didn't cover basic preventive care

ketchup

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Re: What comes after the ACA?
« Reply #3889 on: November 09, 2017, 10:58:31 AM »
They should start providing tax deductions for those with healthy diets who exercise regularly, etc  so much of these healthcare costs are due to preventable conditions (obesity, etc.). For whatever reason, smoking is the only thing they care about, even though obesity related conditions are now the leading cause of preventable illness.
United Healthcare does something like this on my plan through work.  They give you a Fitbit and you get $$ deposited directly into your HSA based on your activity levels.  It actually pushes my insurance cost negative for me.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3890 on: November 09, 2017, 11:00:25 AM »
Quote
And on the other hand, before ACA there were actually much better plans available that you canít even purchase now.

Better in some ways.  While having lower premiums and lower deductibles they almost all:
* had lifetime caps on coverage
* had no out-of-pocket maximums.  For example, there was no point when you didn't pay your 20% of an 80/20 plan
* didn't allow pre-existing conditions (and this was tightly defined - I had a child denied coverage for acne)
* didn't cover basic preventive care

And then you could have even had this coverage and then if for some reason you had a medical event the insurance companies would fight not to have cover the claim.

waltworks

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Re: What comes after the ACA?
« Reply #3891 on: November 09, 2017, 11:05:04 AM »
Well, I for one am enjoying my Trumpcare. Silver plans in UT are expensive as hell... but bronze plans are basically free. We're paying $6 a month (yes, $6) for a perfectly decent bronze plan now.

Truly bizarre, but at least in UT, basic catastrophic/preventative healthcare is now free if you're relatively low income (or can fake it with IRA and 401k contributions).

-W

Exflyboy

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Re: What comes after the ACA?
« Reply #3892 on: November 09, 2017, 11:08:10 AM »
Well, I for one am enjoying my Trumpcare. Silver plans in UT are expensive as hell... but bronze plans are basically free. We're paying $6 a month (yes, $6) for a perfectly decent bronze plan now.

Truly bizarre, but at least in UT, basic catastrophic/preventative healthcare is now free if you're relatively low income (or can fake it with IRA and 401k contributions).

-W

Don't forget additional destituteness can be faked with an HSA in a Bronze plan..:)

jorjor

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Re: What comes after the ACA?
« Reply #3893 on: November 09, 2017, 11:31:00 AM »
Sol or anyone else,

I have seen on multiple occasions people pointing out the health insurance costs are increasing due to the threat/fear of republican interference in the ACA.  Can anyone please share some credible sources that explain that statement better?  I don't want to argue for or against, I just want to see the math behind it for myself.

Thanks

My portion of my employer-provided health insurance has more than doubled in two years. Fortunately it's still exceptionally affordable, but still - there's definitely a trend going on..

Those who pay for health insurance have had to pay more over the years.  Cost has been increasing faster than inflation way before the ACA was even a thought as well as after Trump took office.  The trend is there but I think it may be decades long. And BTW, ACA took affect in 2011



Yep, I believe it.  It's been going on for a long time, but getting hit on the employer side here is new ($13/check when I was hired, $27/check now - still ridiculously cheap, but costs can't have been increasing at this rate all that long, given how low it was when I was hired).

On the bright side, they upped our 401k match. :)

Your cost increase almost certainly has nothing to do with this uncertainty. CSR uncertainty and removal only impacts the individual market. The impact of any individual mandate uncertainty is going to be pretty diluted in a group plan. The total cost for insurance is about $500/mo for single coverage according to the chart above. If you're getting paid twice a month your cost went up $26/mo. That could just be a normal trend increase that your employer decided to leverage on employees instead of themselves this time.

If you're in a large group, you may even be less removed from all of this. A major chunk of large groups are self-insured with some stop-loss coverage so they aren't even "buying insurance" in the traditional sense. They're just paying an administrative fee to the insurer to process claims and do claims management, but are paying the claims themselves so aren't really impacted at all by an insurer's changing risk pool, just the people you work with (and their families, and I guess a minor impact from a reinsurer's stop loss premium).
« Last Edit: November 09, 2017, 11:32:50 AM by jorjor »

waltworks

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Re: What comes after the ACA?
« Reply #3894 on: November 09, 2017, 11:41:38 AM »
Don't forget additional destituteness can be faked with an HSA in a Bronze plan..:)

We're in the semi-FIRE/not working much zone where income is low enough that we have to be careful not to end up on Medicaid. But yes, HSA would help if you were really trying to reduce AGI!

-W

keyvaluepair

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Re: What comes after the ACA?
« Reply #3895 on: November 09, 2017, 11:59:16 AM »
Sadly, I think that the recent election results are going to push Congress to even more ACA repeal. We'll be well and truly f****ed then. I sincerely hope that I am wrong.

Exflyboy

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Re: What comes after the ACA?
« Reply #3896 on: November 09, 2017, 12:12:04 PM »
Sadly, I think that the recent election results are going to push Congress to even more ACA repeal. We'll be well and truly f****ed then. I sincerely hope that I am wrong.

Depends where you're at I guess. I mean if your are FIRED with a substantial pile of moolah your never really screwed. I mean 15% of your investment returns come from the HC industry basically. If that 15% is bigger than you pay in healthcare your on the winning side of the equation right?

I'm not going to like paying full freight on premiums either, in fact if I did I think that would force us to either get a job for say 2 years (assuming employer HC bennies and we could stash say another $200k into investments thus pay for roughly 10 years of healthcare in retirement). Or,... Move out of the country.


keyvaluepair

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Re: What comes after the ACA?
« Reply #3897 on: November 09, 2017, 12:26:44 PM »
Moving out of the country is an interesting option. Suppose you move to Canada. If so, are we still allowed to keep investments in US stock markets?

jim555

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Re: What comes after the ACA?
« Reply #3898 on: November 09, 2017, 12:35:19 PM »
Moving out of the country is an interesting option. Suppose you move to Canada. If so, are we still allowed to keep investments in US stock markets?
It is not that easy to move to another country.  Most are very strict about issuing visas.

Exflyboy

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Re: What comes after the ACA?
« Reply #3899 on: November 09, 2017, 12:36:12 PM »
Moving out of the country is an interesting option. Suppose you move to Canada. If so, are we still allowed to keep investments in US stock markets?

There are many expats who live in different places, plus you are a US Citizen. I am not aware of any law that says you have to empty your 401k and after tax investments... I just did a quick Google search that says there are no restrictions on holding US investments.

We might move back to the UK (my home) and be covered by the national Health Service.. or move to Central Europe or Asia.. All kinds of options.

Now if your a broke working stiff I agree that options will be very limited in that case...:)