Author Topic: What comes after the ACA?  (Read 473257 times)

jorjor

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Re: What comes after the ACA?
« Reply #3900 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 #3901 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 #3902 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 #3903 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 #3904 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 #3905 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 #3906 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 #3907 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 #3908 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 #3909 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 #3910 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 #3911 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 #3912 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...:)

Exflyboy

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Re: What comes after the ACA?
« Reply #3913 on: November 09, 2017, 12:39:23 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.

It takes research I agree but its hardly difficult.. Huge numbers of Americans move and live abroad each year. I quickly looked at Thailand and the Philippines because those places interest me... Both of those its a non issue as long as you meet income requirements.

jim555

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Re: What comes after the ACA?
« Reply #3914 on: November 09, 2017, 12:41:39 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.

It takes research I agree but its hardly difficult.. Huge numbers of Americans move and live abroad each year. I quickly looked at Thailand and the Philippines because those places interest me... Both of those its a non issue as long as you meet income requirements.
They have retirement visas that are not hard to get.  But places like Europe and Canada are looking for specific skills.

keyvaluepair

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Re: What comes after the ACA?
« Reply #3915 on: November 09, 2017, 12:45:22 PM »
Yeah, I hope that it doesn't reach the point where we have to move. We'd have to find a country with a decent school system. So Thailand or Phillipines would be out. I do software and my wife is a data scientist, so hopefully getting a permanent residency won't be as big an issue...

GuitarStv

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Re: What comes after the ACA?
« Reply #3916 on: November 09, 2017, 12:53:16 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?

Yep.  Most Canadians do.

Be aware that there are exit fees for leaving the US with money though.  If you want to retain dual citizenship with the US you will have to file American taxes every year that you live abroad too.

Exflyboy

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Re: What comes after the ACA?
« Reply #3917 on: November 09, 2017, 01:00:09 PM »
You might be surprised, Many third world countries have "EXpat kids schools" that offer very decent education. I lectured for a day at one in the Philippines.. Smart kids mostly headed to US colleges.

You had to pay for it though..


EnjoyIt

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Re: What comes after the ACA?
« Reply #3918 on: November 09, 2017, 01:04:04 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

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

Makes sense....thanks for the link

Exflyboy

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Re: What comes after the ACA?
« Reply #3919 on: November 09, 2017, 01:10:20 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?

Yep.  Most Canadians do.

Be aware that there are exit fees for leaving the US with money though.  If you want to retain dual citizenship with the US you will have to file American taxes every year that you live abroad too.

So if you leave the bulk of your stash in the US (assuming US citizenship) and you retire abroad.. so now you are filling US taxes and just sending enough money abroad to support yourself.. are there exit fees payable in that case?

keyvaluepair

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Re: What comes after the ACA?
« Reply #3920 on: November 09, 2017, 01:15:57 PM »
Yeah, if we went to Canada, we'd probably keep our US citizenship. Just looked at our estimated ACA premiums for 2018 as well - $18K. Non trivial.

Exflyboy

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Re: What comes after the ACA?
« Reply #3921 on: November 09, 2017, 01:27:41 PM »
Yeah, if we went to Canada, we'd probably keep our US citizenship. Just looked at our estimated ACA premiums for 2018 as well - $18K. Non trivial.

indeed... Hence the need to become FI ASAP then quit your job and be "poor".

The $18k would be a level that would have me thinking outside the box for sure, of course not having kids would make that a whole lot easier.

GuitarStv

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Re: What comes after the ACA?
« Reply #3922 on: November 09, 2017, 01:28:56 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?

Yep.  Most Canadians do.

Be aware that there are exit fees for leaving the US with money though.  If you want to retain dual citizenship with the US you will have to file American taxes every year that you live abroad too.

So if you leave the bulk of your stash in the US (assuming US citizenship) and you retire abroad.. so now you are filling US taxes and just sending enough money abroad to support yourself.. are there exit fees payable in that case?

I don't know the exact rules . . . just that the US doesn't let you give up citizenship for free:

https://www.investopedia.com/articles/personal-finance/060515/why-people-renounce-their-us-citizenship.asp

former player

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Re: What comes after the ACA?
« Reply #3923 on: November 09, 2017, 01:59:21 PM »
Yeah, I hope that it doesn't reach the point where we have to move. We'd have to find a country with a decent school system. So Thailand or Phillipines would be out. I do software and my wife is a data scientist, so hopefully getting a permanent residency won't be as big an issue...
Age is often an issue: many developed countries prioritise younger immigrants.  Anyone who is looking at this option should think about doing it sooner rather than later.
Be frugal and industrious, and you will be free (Ben Franklin)

keyvaluepair

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Re: What comes after the ACA?
« Reply #3924 on: November 09, 2017, 03:24:28 PM »
Well, 18K is not too terrible a hit, but it is nearly a third of what what our semi-formal spending limit of $60K is. And it has put the wife in the "I need to find a job" mode - she has now decided that she wants to work for another 10 years (gasp).

Time to do another startup in that case.

Exflyboy

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Re: What comes after the ACA?
« Reply #3925 on: November 09, 2017, 05:19:19 PM »
Well, 18K is not too terrible a hit, but it is nearly a third of what what our semi-formal spending limit of $60K is. And it has put the wife in the "I need to find a job" mode - she has now decided that she wants to work for another 10 years (gasp).

Time to do another startup in that case.

So you would need a minimum of about $2m.. ($60k +$20k @4%).. Or... $1.5m ($60k @ 4%) plus say 12 years * $20k ($240k)..= $1.8m roughly.

Because I'm over cautious I'd want about $2.5m to feel comfortable with that spend.

How close are you guys to these numbers?

keyvaluepair

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Re: What comes after the ACA?
« Reply #3926 on: November 09, 2017, 08:24:56 PM »
We're above. BTW, the 60K was with the insurance factored in. Not 80K.

Exflyboy

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Re: What comes after the ACA?
« Reply #3927 on: November 10, 2017, 05:39:09 PM »
Oh and by way of an example.. In the UK the kids are two years ahead of the US kids by the time they get to highschool.

Many of our expat managers in the UK had a real problem repatriating to the US after being in the UK for a number of years.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3928 on: November 10, 2017, 05:58:18 PM »
Don't forget that if you can keep your AGI between 138%-400% of the federal poverty limit you get subsidies.

sol

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Re: What comes after the ACA?
« Reply #3929 on: November 10, 2017, 06:09:05 PM »
Don't forget that if you can keep your AGI between 138%-400% of the federal poverty limit you get subsidies.

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

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

keyvaluepair

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Re: What comes after the ACA?
« Reply #3930 on: November 10, 2017, 06:21:37 PM »
Yes, indeed! I did the same calculation - see earlier part of the thread. We really only need to spend $60K at a maximum. Just was pointing out that for us given a property tax of nearly $10K and $18K in insurance, that is nearly half of the yearly spend that I don't realize a lot of direct value from. I suppose that the $10K pays for the local school, but it is still a bit nuts. I'd rather that the wife didn't go back to work, but at this point she seems to have determined that she just isn't comfortable with ACA uncertainty and wants to go back. So I guess that I'm only 0.5 FIRE'ed.

talltexan

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Re: What comes after the ACA?
« Reply #3931 on: November 14, 2017, 02:54:03 PM »
https://www.nytimes.com/2017/11/14/us/politics/tax-plan-senate-obamacare-individual-mandate-trump.html

Current draft of tax reform bill does seem to include a major swipe at Affordable Care Act.

nereo

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Re: What comes after the ACA?
« Reply #3932 on: November 14, 2017, 02:57:57 PM »
https://www.nytimes.com/2017/11/14/us/politics/tax-plan-senate-obamacare-individual-mandate-trump.html

Current draft of tax reform bill does seem to include a major swipe at Affordable Care Act.
Yup.  Since the GOP failed at passing their own health care bill AND failed at repealing the ACA they are back to "option c: just sabotage the ACA"

Option C seems like the absolute worst outcome - we're undermining what we've got at the expense of the sick without any backup.
Who will get blamed?
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FIREchiefsr

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Re: What comes after the ACA?
« Reply #3933 on: November 14, 2017, 03:05:31 PM »
https://www.nytimes.com/2017/11/14/us/politics/tax-plan-senate-obamacare-individual-mandate-trump.html

Current draft of tax reform bill does seem to include a major swipe at Affordable Care Act.
Yup.  Since the GOP failed at passing their own health care bill AND failed at repealing the ACA they are back to "option c: just sabotage the ACA"

Option C seems like the absolute worst outcome - we're undermining what we've got at the expense of the sick without any backup.
Who will get blamed?

I'm pretty sure that, at the end of the day, Obama will still be blamed for everything.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

jim555

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Re: What comes after the ACA?
« Reply #3934 on: November 14, 2017, 03:10:58 PM »
End the mandate.  Rates rise since only the sick will buy insurance and not the young and healthy.  Those over the 400% line get screwed while those under 400% get mostly made whole by subsidies.  Federal government pays billions more.  Sounds like another sabotage backfire.

DumpTruck

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Re: What comes after the ACA?
« Reply #3935 on: November 14, 2017, 03:13:35 PM »
from my perspective, it doesn't matter which party is in office. the office holders do the bidding of the corporations. the government was created for corporations, by corporations. The insurance companies are the ones who have created the most drag in healthcare and promoted procedure based medicine and insulated the market from demand side pressures.

But i also dont know that much about it so I could be wrong. But in most cases I'm right ;)

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3936 on: November 14, 2017, 08:29:24 PM »
How crazy to complicate the tax bill with another effort to essentially repeal Obamacare by getting rid of the individual health insurance mandate.
Already Susan Collins of Maine sounds skeptical. Perhaps Murkowski and McCain would also reject the tax proposal if it included repeal of the mandate.
 
Senate Plans to End Obamacare Mandate in Revised Tax Proposal
https://nyti.ms/2jqCW0K

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3937 on: November 14, 2017, 10:47:01 PM »
End the mandate.  Rates rise since only the sick will buy insurance and not the young and healthy.  Those over the 400% line get screwed while those under 400% get mostly made whole by subsidies.  Federal government pays billions more.  Sounds like another sabotage backfire.

You say one thing, and then end up with something totally different.  'Only the sick will buy insurance' (true), then 'only those over 400% FPL get screwed' (false).  This is a simple misconception, but when the individual mandate gets repealed and all of the healthy people opt out, those that need healthcare will have to pay tremendously more.  If you are wealthy and need a little healthcare, probably a little screwed, but if you are poor, you still end up on Medicaid.  Those in the middle get to pay 'hugely' more premiums or 'hugely' more deductibles.  I know that doesn't sound that much different from this year, but it is gonna be unstopppable and bad.  We are sending the cruise ship in the wrong direction and it won't turn around quickly.
Transitioning to FIRE'd albeit somewhat cautiously...

Exflyboy

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Re: What comes after the ACA?
« Reply #3938 on: November 14, 2017, 11:17:48 PM »
End the mandate.  Rates rise since only the sick will buy insurance and not the young and healthy.  Those over the 400% line get screwed while those under 400% get mostly made whole by subsidies.  Federal government pays billions more.  Sounds like another sabotage backfire.

You say one thing, and then end up with something totally different.  'Only the sick will buy insurance' (true), then 'only those over 400% FPL get screwed' (false).  This is a simple misconception, but when the individual mandate gets repealed and all of the healthy people opt out, those that need healthcare will have to pay tremendously more.  If you are wealthy and need a little healthcare, probably a little screwed, but if you are poor, you still end up on Medicaid.  Those in the middle get to pay 'hugely' more premiums or 'hugely' more deductibles.  I know that doesn't sound that much different from this year, but it is gonna be unstopppable and bad.  We are sending the cruise ship in the wrong direction and it won't turn around quickly.

Probably a good time to look at living somewhere other than the US if the individual mandate gets repealed (assuming FIRED status).

At least then one can start doing 401-IRA-Roth conversions and not worry about maximising subsidies..:)

sol

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Re: What comes after the ACA?
« Reply #3939 on: November 15, 2017, 12:02:00 AM »
Probably a good time to look at living somewhere other than the US if the individual mandate gets repealed

I'm not quite ready to give up on America yet.  I was born an American citizen and I intend to die an American citizen, and in between my country's mistakes are mine to bear.  Okay, so we may have tortured some people.  And yes, we kind of bombed some hospitals full of children but that was a mistake both times.  And yes we've technically overthrown some democratically elected leaders, but only because we thought the overarching cause of democracy was better served by temporarily suspending democracy.

And yes we technically elected one of the least qualified people in the country to represent us on the international stage and yes he's kind of fucked it up, but it was kind of meant to be a joke and I think we're all aware that it's not very funny anymore. 

But health care, that one is easy.  It's kind of sort of working okay right now, so all we have to do is NOT fuck it up too much in the short term, while we talk about how to fix some of the longer term problems.  If I wasn't prepared to abandon America after torture and child murder and such, I'm sure as hell not about to bail out over a health insurance fuck up.

I think your principles might need examining, if this is the thing that causes you to finally flee the country.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3940 on: November 15, 2017, 04:38:07 AM »
Probably a good time to look at living somewhere other than the US if the individual mandate gets repealed

I'm not quite ready to give up on America yet.  I was born an American citizen and I intend to die an American citizen, and in between my country's mistakes are mine to bear.  Okay, so we may have tortured some people.  And yes, we kind of bombed some hospitals full of children but that was a mistake both times.  And yes we've technically overthrown some democratically elected leaders, but only because we thought the overarching cause of democracy was better served by temporarily suspending democracy.

And yes we technically elected one of the least qualified people in the country to represent us on the international stage and yes he's kind of fucked it up, but it was kind of meant to be a joke and I think we're all aware that it's not very funny anymore. 

But health care, that one is easy.  It's kind of sort of working okay right now, so all we have to do is NOT fuck it up too much in the short term, while we talk about how to fix some of the longer term problems.  If I wasn't prepared to abandon America after torture and child murder and such, I'm sure as hell not about to bail out over a health insurance fuck up.

I think your principles might need examining, if this is the thing that causes you to finally flee the country.

Don't forget that Exflyboy is a British expat, so he probably doesn't have the same sentimental attachment to this fucked up place that you and I have.
"Take this job and shove it" - David Allan Coe

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3941 on: November 15, 2017, 04:45:53 AM »
The buzz this morning is that Senate Republicans are offering to move the Alexander-Murray compromise in exchange for inserting the repeal of the individual mandate into the tax bill.  The "copper" plans included in that compromise might reduce the number of people who go without insurance entirely, but on the other hand might hasten the death spiral of the more expensive plans.
"Take this job and shove it" - David Allan Coe

obstinate

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Re: What comes after the ACA?
« Reply #3942 on: November 15, 2017, 05:38:57 AM »
End the mandate.  Rates rise since only the sick will buy insurance and not the young and healthy.  Those over the 400% line get screwed while those under 400% get mostly made whole by subsidies.  Federal government pays billions more.  Sounds like another sabotage backfire.

You say one thing, and then end up with something totally different.  'Only the sick will buy insurance' (true), then 'only those over 400% FPL get screwed' (false).  This is a simple misconception, but when the individual mandate gets repealed and all of the healthy people opt out, those that need healthcare will have to pay tremendously more.  If you are wealthy and need a little healthcare, probably a little screwed, but if you are poor, you still end up on Medicaid.  Those in the middle get to pay 'hugely' more premiums or 'hugely' more deductibles.  I know that doesn't sound that much different from this year, but it is gonna be unstopppable and bad.  We are sending the cruise ship in the wrong direction and it won't turn around quickly.
Those with under 400% fpl get subsidies. If thats who you mean when you talk about the middle, I don't really see how they are screwed.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3943 on: November 15, 2017, 07:07:03 AM »
End the mandate.  Rates rise since only the sick will buy insurance and not the young and healthy.  Those over the 400% line get screwed while those under 400% get mostly made whole by subsidies.  Federal government pays billions more.  Sounds like another sabotage backfire.

You say one thing, and then end up with something totally different.  'Only the sick will buy insurance' (true), then 'only those over 400% FPL get screwed' (false).  This is a simple misconception, but when the individual mandate gets repealed and all of the healthy people opt out, those that need healthcare will have to pay tremendously more.  If you are wealthy and need a little healthcare, probably a little screwed, but if you are poor, you still end up on Medicaid.  Those in the middle get to pay 'hugely' more premiums or 'hugely' more deductibles.  I know that doesn't sound that much different from this year, but it is gonna be unstopppable and bad.  We are sending the cruise ship in the wrong direction and it won't turn around quickly.
Those with under 400% fpl get subsidies. If thats who you mean when you talk about the middle, I don't really see how they are screwed.

1.  Subsidies aren't keeping up with insurance premium increases, and certainly not offsetting the reductions in coverage and deductible increases.  2.  Do you really think the government is going to pay more in the future to support a subsidized system through 2020?  They can't wait for it to crash and burn (as it is currently doing in a slow train-wreck that is accelerating, if you hadn't noticed).

The worst possible place to be going forward is 'too much income to be on Medicaid' but too little wealth and/or income to have options.
Transitioning to FIRE'd albeit somewhat cautiously...

AdrianC

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Re: What comes after the ACA?
« Reply #3944 on: November 15, 2017, 07:11:40 AM »
https://www.nytimes.com/2017/11/14/us/politics/tax-plan-senate-obamacare-individual-mandate-trump.html

Current draft of tax reform bill does seem to include a major swipe at Affordable Care Act.

NYT: "Eliminating the individual mandate and having far fewer people signed up for insurance saves money because many of those people receive federal subsidies to buy coverage."

Does it follow that "far fewer people" will sign up for coverage?

If they're smart they'll still get coverage and continue to get large subsidies. But...are they smart?

The penalty is a maximum of $695 per adult and $2,085 per family. I reckon most folks would be better off getting the insurance.

The people who make too much to get subsidies are screwed yet again, of course.

AdrianC

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Re: What comes after the ACA?
« Reply #3945 on: November 15, 2017, 07:13:54 AM »
1.  Subsidies aren't keeping up with insurance premium increases

You sure about that?

maizeman

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Re: What comes after the ACA?
« Reply #3946 on: November 15, 2017, 07:32:16 AM »
1.  Subsidies aren't keeping up with insurance premium increases, and certainly not offsetting the reductions in coverage and deductible increases.  2.  Do you really think the government is going to pay more in the future to support a subsidized system through 2020?  They can't wait for it to crash and burn (as it is currently doing in a slow train-wreck that is accelerating, if you hadn't noticed).

The worst possible place to be going forward is 'too much income to be on Medicaid' but too little wealth and/or income to have options.

I don't think #1 is supported by the data. People who qualify for subsidies are actually seeing their prices come down this year (for bronze and gold level plans anyway, silver plans are generally flat), and deductibles are basically maxed out for plans at each insurance level, so as far as I know deductibles aren't actually increasing.

#2 is certainly a valid concern. The premium subsidy increases are automatic process that would require a vote of congress to change. Right now our government is so dysfunctional that I doubt it could get a consensus to actually successfully pass ANYTHING. But I'll stipulate that is certainly subject to change in each coming election.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3947 on: November 15, 2017, 08:59:04 AM »

1.  Subsidies aren't keeping up with insurance premium increases, and certainly not offsetting the reductions in coverage and deductible increases. 

Incorrect.
My subsidies have increased so much that my 2018 health insurance costs a fraction of what it did for 2017.

brooklynguy

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Re: What comes after the ACA?
« Reply #3948 on: November 15, 2017, 09:14:25 AM »

1.  Subsidies aren't keeping up with insurance premium increases, and certainly not offsetting the reductions in coverage and deductible increases. 

Incorrect.
My subsidies have increased so much that my 2018 health insurance costs a fraction of what it did for 2017.

By design, the premium tax credits keep pace with premium increases in order to keep the net cost flat for subsidized enrollees (though, as the current machinations in response to the defunding of cost-sharing payment reimbursements clearly demonstrate, there can be differential impact across different plan metal level types).

The bigger problem with eliminating the individual mandate without any alternative mechanism for incentivizing healthy individuals to continue to purchase coverage, though, is, as others have noted, in the short-term, the effect on unsubsidized enrollees, when premiums increase, and, in the long-term, the effect on everyone, when the entire individual health insurance market implodes via death spiral.

jim555

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Re: What comes after the ACA?
« Reply #3949 on: November 15, 2017, 09:35:34 AM »
The ACA puts a cap on the most the Feds will pay in subsidies and CSRs to 0.504% of GDP.  Starting in 2019 the subsidy percentages are adjusted if the total exceeds 0.504%, causing the amount paid by person to increase.  This will become a big factor over the next several years.