Author Topic: What comes after the ACA?  (Read 1469480 times)

SugarMountain

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Re: What comes after the ACA?
« Reply #5850 on: February 11, 2020, 11:02:56 AM »
That's why the individual mandate is logically inseverable from guaranteed issue.  Without the mandate, people could just sign up for "insurance" when they get sick,

No, it doesn't work that way.   That's why you have to sign up for a policy during open enrollment unless you have a special qualifying event, like losing your insurance through work, to prevent people from gaming the system.

The markets have proved they continue to work with the $0 penalty to enforce the mandate, so they would continue to work without the mandate altogether, as well.

Except now you can get cheap dogshit "short term" policies and then if you do end up with something serious have that carry you until you get to an ACA enrollment period and get better coverage.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5851 on: February 11, 2020, 12:00:20 PM »
If you get a medical bill that the short term policy won't pay, you still have to pay it out of your pocket, even if you will later get a better long-term ACA plan.

Mr. Green

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Re: What comes after the ACA?
« Reply #5852 on: February 11, 2020, 02:09:58 PM »
If you get a medical bill that the short term policy won't pay, you still have to pay it out of your pocket, even if you will later get a better long-term ACA plan.
That's why they're cheap dogshit policies!

American GenX

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Re: What comes after the ACA?
« Reply #5853 on: February 11, 2020, 04:24:45 PM »
Precisely why using insurance to provide healthcare is a bad idea. You know as a society you have to provide care for your people so stop trying to make money off the process.

But that makes me sound like a Socialist and therefore I am going to Hell..

You are excused as you are an Englishman and grew up used to better health care that cost less money that covered everybody.  However, it won't work here because,......because,.......because,......well just because OK!

I know someone who lives in the UK who's thinking of moving to Canada next year. I asked them why even consider Canada and not the US if coming to North America. They said "Uh, US healthcare is garbage and you're freakin' gun crazy."

Fair enough.

Hmmm.  I've worked in the healthcare industry in the U.S., and when it comes to what's best for my health, I would rather receive healthcare treatment in the U.S. than anywhere.  Even many Canadians come to the U.S. for some healthcare needs.  I don't know anyone who is gun crazy, so I wouldn't let that stop me from coming here if I was from another country.

pecunia

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Re: What comes after the ACA?
« Reply #5854 on: February 11, 2020, 04:50:30 PM »
Precisely why using insurance to provide healthcare is a bad idea. You know as a society you have to provide care for your people so stop trying to make money off the process.

But that makes me sound like a Socialist and therefore I am going to Hell..

You are excused as you are an Englishman and grew up used to better health care that cost less money that covered everybody.  However, it won't work here because,......because,.......because,......well just because OK!

I know someone who lives in the UK who's thinking of moving to Canada next year. I asked them why even consider Canada and not the US if coming to North America. They said "Uh, US healthcare is garbage and you're freakin' gun crazy."

Fair enough.

Hmmm.  I've worked in the healthcare industry in the U.S., and when it comes to what's best for my health, I would rather receive healthcare treatment in the U.S. than anywhere.  Even many Canadians come to the U.S. for some healthcare needs.  I don't know anyone who is gun crazy, so I wouldn't let that stop me from coming here if I was from another country.

They need more spokesmen like yourself.  The personal appeal keeps us from looking too hard at the facts.  The health care industry thanks you.

rantk81

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Re: What comes after the ACA?
« Reply #5855 on: February 12, 2020, 07:37:54 AM »
Bajeez... For the millionth time... The problem in the US isn't the quality of care. It is the cost/access to care that is the big f-ing problem.  Anyone who keeps saying "we can't change anything because the doctors in the USA are great!" is just creating a side-show to the actual problem!

Omy

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Re: What comes after the ACA?
« Reply #5856 on: February 12, 2020, 09:06:17 AM »
Agreed. While I love my doctors and care, it shouldn't cost $1300/mo to have a $9000 deductible (which I hope not to meet). If I am unable to play the subsidy game - or if the ACA is dismantled bit by bit - my prices will become astronomically higher and my level of care will be reduced significantly because the current health care model dictates that profits are more important than the overall health of the populace!

Exflyboy

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Re: What comes after the ACA?
« Reply #5857 on: February 12, 2020, 07:10:48 PM »
Agreed. While I love my doctors and care, it shouldn't cost $1300/mo to have a $9000 deductible (which I hope not to meet). If I am unable to play the subsidy game - or if the ACA is dismantled bit by bit - my prices will become astronomically higher and my level of care will be reduced significantly because the current health care model dictates that profits are more important than the overall health of the populace!

Scary how easy it is to hit that $9k max OOP.. In fact my broken wrist and surgery resulted in bills of $26,000, which got written down to about $12k.

And then there is the BS about networks that are almost unusable. Thankfully all my bills were in network.

pecunia

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Re: What comes after the ACA?
« Reply #5858 on: February 12, 2020, 07:16:28 PM »
I just had this thought.  Taken as a percentage I'm sure that the amount spent by the health care industry on buying politicians is a far smaller proportion of their income than the percentage of the income of whomever reads this to pay for premiums.  From their perspective, it was money well spent.


former player

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Re: What comes after the ACA?
« Reply #5859 on: February 12, 2020, 08:13:21 PM »
Precisely why using insurance to provide healthcare is a bad idea. You know as a society you have to provide care for your people so stop trying to make money off the process.

But that makes me sound like a Socialist and therefore I am going to Hell..

You are excused as you are an Englishman and grew up used to better health care that cost less money that covered everybody.  However, it won't work here because,......because,.......because,......well just because OK!

I know someone who lives in the UK who's thinking of moving to Canada next year. I asked them why even consider Canada and not the US if coming to North America. They said "Uh, US healthcare is garbage and you're freakin' gun crazy."

Fair enough.
Money and demographics would protect me from the worst of guns and health care coverage but I couldn't bear to support US levels of political corruption.

SeaG1ant

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Re: What comes after the ACA?
« Reply #5860 on: February 13, 2020, 06:26:18 AM »
I'm going to post something positive on this thread...

United Healthcare / Anthem are seeing pretty nice earnings increases and their benefit / expense ratio is starting to decline.  This should mean ACA plans don't increase as much next year (or even decrease) and the big insurers start going back into markets they abandoned.

This matters to me because my hometown I could domicile my address in and go nomadic doesn't have a single Big 4 provider and the local network plan has some serious issues getting to see specialists.

Padonak

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Re: What comes after the ACA?
« Reply #5861 on: February 15, 2020, 08:48:01 AM »
I'm going to post something positive on this thread...

United Healthcare / Anthem are seeing pretty nice earnings increases and their benefit / expense ratio is starting to decline.  This should mean ACA plans don't increase as much next year (or even decrease) and the big insurers start going back into markets they abandoned.

This matters to me because my hometown I could domicile my address in and go nomadic doesn't have a single Big 4 provider and the local network plan has some serious issues getting to see specialists.

Is there a way to look up available ACA providers and plans for a specific address? I am also planning to go nomadic and trying to choose a mail forwarding/remote address company for that in a tax free state like FL, TX or ND.

Shane

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Re: What comes after the ACA?
« Reply #5862 on: February 15, 2020, 02:46:10 PM »
I'm going to post something positive on this thread...

United Healthcare / Anthem are seeing pretty nice earnings increases and their benefit / expense ratio is starting to decline.  This should mean ACA plans don't increase as much next year (or even decrease) and the big insurers start going back into markets they abandoned.

This matters to me because my hometown I could domicile my address in and go nomadic doesn't have a single Big 4 provider and the local network plan has some serious issues getting to see specialists.

Is there a way to look up available ACA providers and plans for a specific address? I am also planning to go nomadic and trying to choose a mail forwarding/remote address company for that in a tax free state like FL, TX or ND.

Traveling Mailbox worked well for us while we were on the road full time for 2 years.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5863 on: February 15, 2020, 02:52:52 PM »
I'm going to post something positive on this thread...

United Healthcare / Anthem are seeing pretty nice earnings increases and their benefit / expense ratio is starting to decline.  This should mean ACA plans don't increase as much next year (or even decrease) and the big insurers start going back into markets they abandoned.

This matters to me because my hometown I could domicile my address in and go nomadic doesn't have a single Big 4 provider and the local network plan has some serious issues getting to see specialists.

Is there a way to look up available ACA providers and plans for a specific address? I am also planning to go nomadic and trying to choose a mail forwarding/remote address company for that in a tax free state like FL, TX or ND.
That's not how it works. You need to actually establish residency in a state in order to qualify for the subsidies in that state. Once that's done, the location of your mail forwarding company doesn't matter.

Shane

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Re: What comes after the ACA?
« Reply #5864 on: February 15, 2020, 10:49:04 PM »
I'm going to post something positive on this thread...

United Healthcare / Anthem are seeing pretty nice earnings increases and their benefit / expense ratio is starting to decline.  This should mean ACA plans don't increase as much next year (or even decrease) and the big insurers start going back into markets they abandoned.

This matters to me because my hometown I could domicile my address in and go nomadic doesn't have a single Big 4 provider and the local network plan has some serious issues getting to see specialists.

Is there a way to look up available ACA providers and plans for a specific address? I am also planning to go nomadic and trying to choose a mail forwarding/remote address company for that in a tax free state like FL, TX or ND.
That's not how it works. You need to actually establish residency in a state in order to qualify for the subsidies in that state. Once that's done, the location of your mail forwarding company doesn't matter.

This article is a pretty good primer on how to establish legal residence for nomads. As mentioned in the linked blog post, some car insurance companies, banks, etc., will insist on having a legal physical address, and they won't accept a mail forwarder's address for that. One way we've found to get around that issue is to physically go to the state where you are trying to establish residency, rent an Airbnb house or apartment for a week or a month and, then, use that physical address to register and insure your car, register to vote, and as the physical address for your various accounts. As long as you set up all of your accounts to be electronic, nobody should send any actual mail to your physical address, anyway. Give everyone your mail forwarder's address as your "mailing address."

Padonak

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Re: What comes after the ACA?
« Reply #5865 on: February 16, 2020, 09:36:59 AM »
thank you @Shane 

I'll read the article. Which location did you choose for your mailbox if you don't mind me asking?

When you chose your location, did you take into account ACA plans availability and cost?

Shane

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Re: What comes after the ACA?
« Reply #5866 on: February 16, 2020, 10:02:57 PM »
thank you @Shane 

I'll read the article. Which location did you choose for your mailbox if you don't mind me asking?

When you chose your location, did you take into account ACA plans availability and cost?

@Padonak We chose Sanford, NC, for our mailing address, because that's Traveling Mailbox's central office, and we read that their mail processing times there would be the fastest. We just continued to use the physical address where we had been living before leaving to travel. Never mentioned to our banks or CC companies that we were no longer physically living at that address. Only changed our mailing address to NC. As we were already covered by insurance in the state where we had been living, we just kept that insurance while we were on the road.

freya

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Re: What comes after the ACA?
« Reply #5867 on: February 21, 2020, 07:26:59 AM »
Agreed. While I love my doctors and care, it shouldn't cost $1300/mo to have a $9000 deductible (which I hope not to meet). If I am unable to play the subsidy game - or if the ACA is dismantled bit by bit - my prices will become astronomically higher and my level of care will be reduced significantly because the current health care model dictates that profits are more important than the overall health of the populace!

Good Lord, is that what you were paying pre-Obamacare?

I think it would be great if catastrophic insurance policies became available again.  They'd pair well with health sharing ministries, and might give you pretty decent "silver" coverage or better at a much lower cost - provided those catastrophic policies are not ridiculously expensive.  Or simply choose to self-insure for the large deductible.   There are so many great options now for arranging your own care at low cost, e.g. direct to consumer labs, and telemedicine visits for simple stuff that really don't require an in-person, $250 visit.

American GenX

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Re: What comes after the ACA?
« Reply #5868 on: February 21, 2020, 07:49:19 AM »
Agreed. While I love my doctors and care, it shouldn't cost $1300/mo to have a $9000 deductible (which I hope not to meet). If I am unable to play the subsidy game - or if the ACA is dismantled bit by bit - my prices will become astronomically higher and my level of care will be reduced significantly because the current health care model dictates that profits are more important than the overall health of the populace!

Good Lord, is that what you were paying pre-Obamacare?

That must be ACA pricing as Omy said it would go up if unable to play the subsidy game.  Since Medicare isn't available until age 65, I just ran an estimate on the marketplace for a 60 year old couple that doesn't get subsidies and came up with this:

Health Alliance Silver plan on ACA marketplace:

$2414.90/mo

$14,400 deductible

$16,300 out of pocket maximum

Those health share ministries are not a valid substitute for real insurance and sometimes do not pay.

Omy

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Re: What comes after the ACA?
« Reply #5869 on: February 21, 2020, 09:18:49 AM »
Those are our current COBRA numbers. ACA was much worse than COBRA (similar to what American GenX reported). We make too much to qualify for subsidies so it's pretty ugly.

Padonak

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Re: What comes after the ACA?
« Reply #5870 on: February 21, 2020, 09:26:20 AM »
Whats the lowest amount a person can pay for an aca plan including premiums and all out of pocket costs, assuming they max out their out of pocket maximum but dont use any out of network providers?

For example, a single filer who is frugal and FI, can change their MAGI by doing Roth conversions, tax loss harvesting etc and make it just a couple of hundred dollars above the minimum income needed to qualify for aca. What would be the maximum yearly expenses in this case? Does it vary by state?
« Last Edit: February 21, 2020, 09:33:13 AM by Padonak »

Paul der Krake

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Re: What comes after the ACA?
« Reply #5871 on: February 21, 2020, 10:00:41 AM »
Plans vary by county, not just state. You'd have to analyze thousands of combinations to get an exact answer.

OOP maximums are capped on the high side, but not on the low side. CSRs play a big role in OOP maximums too.

jim555

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Re: What comes after the ACA?
« Reply #5872 on: February 21, 2020, 11:15:02 AM »
Gives actual numbers by location, income, family size.

https://www.kff.org/interactive/subsidy-calculator/

Padonak

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Re: What comes after the ACA?
« Reply #5873 on: February 21, 2020, 11:16:09 AM »
Isnt there a total cap with cost sharing subsidies at the federal level? For example, if your income is less than $X, we will pay for everything you spend above $Y including premiums and out of pocket costs.

American GenX

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Re: What comes after the ACA?
« Reply #5874 on: February 21, 2020, 11:40:47 AM »

Of course, if the claim is denied, your out of pocket costs can be even higher than the marketplace plan shows.

https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/

Exflyboy

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Re: What comes after the ACA?
« Reply #5875 on: February 21, 2020, 11:59:54 AM »
Denied claims and of course sometimes your insurance company will simply make a "mistake" (always in their favour naturally).

My recent surgery resulted in the insurer claiming I failed to get a referral for the anesthesiologist. Complete BS of course.

When I called the insurer the rep told it was actually pretty rare for customers to call them about "errors" on the Explanation of Benefits (EOB)... That "error" was a $1000 extra out of MY pocket.

Now this was for a simple surgery that resulted in 30 odd line items of charges. I can't imagine what the list would look like for a complex illness/accident.

Bottom line, keep a keen eye on EOBs and make sure that you understand every detail of what is required in terms of getting referrals etc before accepting any care. When my surgeon's office told me they get the approvals for the surgery I made sure I got from the insurance company that their permission had been granted.

Assume they will try to find anyway they can to wriggle out of paying, because they probably will.

Mr. Green

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Re: What comes after the ACA?
« Reply #5876 on: February 21, 2020, 04:49:10 PM »
Whats the lowest amount a person can pay for an aca plan including premiums and all out of pocket costs, assuming they max out their out of pocket maximum but dont use any out of network providers?

For example, a single filer who is frugal and FI, can change their MAGI by doing Roth conversions, tax loss harvesting etc and make it just a couple of hundred dollars above the minimum income needed to qualify for aca. What would be the maximum yearly expenses in this case? Does it vary by state?
I can give you the answer to this based on plans in my area. Since subsidies are based on the second lowest cost silver plan, we have enough silver plans where I live that a very nice one has no premium because the subsidy is higher.

So then your total out of pocket cost is just whatever the limit is for your subsidy level. At the 94% cost sharing reduction level the deductible is $250 and max out of pocket is $650 for a single person on the planet I mentioned above that has no premium.

So your maximum outlay for in network costs is capped at $650 for the year if you find yourself in this scenario, which is as subsidized as it gets before you hit Medicaid.
« Last Edit: February 21, 2020, 04:51:28 PM by Mr. Green »

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5877 on: February 22, 2020, 07:19:32 AM »
Denied claims and of course sometimes your insurance company will simply make a "mistake" (always in their favour naturally).

My recent surgery resulted in the insurer claiming I failed to get a referral for the anesthesiologist. Complete BS of course.

When I called the insurer the rep told it was actually pretty rare for customers to call them about "errors" on the Explanation of Benefits (EOB)... That "error" was a $1000 extra out of MY pocket.

Now this was for a simple surgery that resulted in 30 odd line items of charges. I can't imagine what the list would look like for a complex illness/accident.

Bottom line, keep a keen eye on EOBs and make sure that you understand every detail of what is required in terms of getting referrals etc before accepting any care. When my surgeon's office told me they get the approvals for the surgery I made sure I got from the insurance company that their permission had been granted.

Assume they will try to find anyway they can to wriggle out of paying, because they probably will.

I'm a bit confused as to what on the EOB explains what was going on?
Did it say, "out of network anesthesiologist charge ---- $1,000"

Not sure what detail you saw that helped you figure this out.

rantk81

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Re: What comes after the ACA?
« Reply #5878 on: February 22, 2020, 08:06:04 AM »
There are almost an endless number of reasons insurance companies can deny claims... Even if you see an "in-network" provider.  Some of the ones I'm "familiar" with are:

1. The provider is technically part of your network, but works out of multiple locations. And the provider is only considered to be "in-network" at one of those locations, not the one where you saw the provider.

2. The claim for some service is considered/supposed to be included with another claim for a service, and is not separately reimbursable.

3. You did not get a referral to that provider, and your plan requires referrals.

4. You had a procedure or diagnostic test done that requires "pre-certification" with the insurance company ahead of time, and you failed to get "pre-certified."

5. You received a service that is not covered by your plan.

6. You receive a service/drug that could be covered by your plan, but unbeknownst to you, you were required to try other (less expensive) treatments first, before proceeding to the service or drugs you ultimately ended up receiving.

7. Insurance company says that the provider didn't submit all the required information with the claim.

8. The insurance company and provider both say that the provider is "part of your network" before you receive service... But you later find out that on the actual date of service, the provider was no longer part of the network.  Sorry!

9. And then there is everyone's favorite "You go to an in-network facility, and didn't have the option to pick and choose every single provider who sees or bills you, and later find out that the doctors were 'independent contractors' who are not part of your network, but just happen to be 'contracting' in that facility."

These are just the ones that come to mind off the top of my head.

This system of payments/reimbursement/insurance is a steaming pile of shit and needs to be disrupted and completely blown up.
« Last Edit: February 22, 2020, 08:11:22 AM by rantk81 »

Exflyboy

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Re: What comes after the ACA?
« Reply #5879 on: February 22, 2020, 11:19:17 AM »
Denied claims and of course sometimes your insurance company will simply make a "mistake" (always in their favour naturally).

My recent surgery resulted in the insurer claiming I failed to get a referral for the anesthesiologist. Complete BS of course.

When I called the insurer the rep told it was actually pretty rare for customers to call them about "errors" on the Explanation of Benefits (EOB)... That "error" was a $1000 extra out of MY pocket.

Now this was for a simple surgery that resulted in 30 odd line items of charges. I can't imagine what the list would look like for a complex illness/accident.

Bottom line, keep a keen eye on EOBs and make sure that you understand every detail of what is required in terms of getting referrals etc before accepting any care. When my surgeon's office told me they get the approvals for the surgery I made sure I got from the insurance company that their permission had been granted.

Assume they will try to find anyway they can to wriggle out of paying, because they probably will.

I'm a bit confused as to what on the EOB explains what was going on?
Did it say, "out of network anesthesiologist charge ---- $1,000"

Not sure what detail you saw that helped you figure this out.

One the EOB there are codes, with a little explanation of what each code means. One of those said something about no referral
 They did fix it after I challenged them on it.




Padonak

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Re: What comes after the ACA?
« Reply #5880 on: February 22, 2020, 01:31:26 PM »
Gives actual numbers by location, income, family size.

https://www.kff.org/interactive/subsidy-calculator/

Thanks a lot, exactly what I was looking for

seattlecyclone

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Re: What comes after the ACA?
« Reply #5881 on: February 22, 2020, 04:32:40 PM »
Isnt there a total cap with cost sharing subsidies at the federal level? For example, if your income is less than $X, we will pay for everything you spend above $Y including premiums and out of pocket costs.

Actually there is a federal cap. See Table 4 on this page. If you made just above the threshold to qualify for ACA plans (as opposed to Medicaid), your 94% cost sharing silver plan can have out-of-pocket costs no higher than $2,700 for a single person or $5,400 for a family.

That said, the actual number will vary from plan to plan, county to county. The above limit is just one of many parameters they have to meet when designing the plan. For example in my county there are 14 silver plans from six different insurers. The deductibles on the 94% cost sharing versions of these plans range from $0 to $775 for a single person, and the out-of-pocket maximums range from $575 to $2,700. Only one of the plans is at the federal maximum of $2,700, while the next highest is at $1,500. Premiums of course vary as well, by more than $100/month from the cheapest to most expensive.

joshuagraham_xyz

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Re: What comes after the ACA?
« Reply #5882 on: February 23, 2020, 09:34:56 PM »
To be fair, if you have a preexisting condition and are trying to get a new insurance policy in order to pay for treatment, you're not looking for insurance. You're looking for charity. Insurance is about managing the risk of a low-probability, high-impact event across a larger number of people. If you've a preexisting condition, its no longer a question of risk--to the insurance company, you are certain to cost them far more than you'll ever pay in premiums, so naturally it makes no sense for them to pick you up as a customer.

That's why the individual mandate is logically inseverable from guaranteed issue.  Without the mandate, people could just sign up for "insurance" when they get sick, and either insurance companies go belly up (and nobody can get insurance) or premiums skyrocket (and nobody can afford it).

This is true, but there is a lockout during the year (although that could be worked by simply officially moving to another region, etc.), so the subscriber would have to wait until the new year to sign up.  As for myself, since I am fully Rothed out, my income is low enough to get the Medicaid expansion.

American GenX

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Re: What comes after the ACA?
« Reply #5883 on: February 23, 2020, 10:04:51 PM »
To be fair, if you have a preexisting condition and are trying to get a new insurance policy in order to pay for treatment, you're not looking for insurance. You're looking for charity. Insurance is about managing the risk of a low-probability, high-impact event across a larger number of people. If you've a preexisting condition, its no longer a question of risk--to the insurance company, you are certain to cost them far more than you'll ever pay in premiums, so naturally it makes no sense for them to pick you up as a customer.

That's why the individual mandate is logically inseverable from guaranteed issue.  Without the mandate, people could just sign up for "insurance" when they get sick, and either insurance companies go belly up (and nobody can get insurance) or premiums skyrocket (and nobody can afford it).

This is true, but there is a lockout during the year (although that could be worked by simply officially moving to another region, etc.), so the subscriber would have to wait until the new year to sign up.

That was already addressed in the earlier responses to that comment.

Quote
As for myself, since I am fully Rothed out, my income is low enough to get the Medicaid expansion.

The Medicaid expansion is actually part of the Affordable Care Act, which is still in the courts after being ruled unconstitutional.  If the ACA falls, so does the Medicaid expansion.

joshuagraham_xyz

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Re: What comes after the ACA?
« Reply #5884 on: February 23, 2020, 11:11:25 PM »
I will briefly  relate our saga of staying on an ACA policy for the last few months until DH can get on the government teat of Medicare.

Briefly, he has zero income. He had  zero income a few months ago when the ACA allowed him to have an ACA policy.

A few months ago I qualified for an ACA policy because I had appropriate income. He was on “my” ACA account. Then I moved to Medicare. He will soon be eligible for Medicare but
ACA threatened to drop him when I dropped our AC?a policy.

The phone drones at ACA Central asked him how much his income is and he truthfully answered $0. He has the same income he had four  months ago which is a household income. I share it with him. We file taxes jointly,  and come tax time we will file exactly as we did last year. ACA subsidies will be determined on that basis.

But the phone drones couldn’t wrap their heads around it and determined he was a Medicaid eligible person except that we don’t have expanded Medicaid in my state. And him being on Medicaid is ridiculous anyway, so ridiculous I cannot even contemplate that. That aint gonna happen, We would go private insurance before doing Medicaid.

So after several weeks of back-and-forthing with some paperwork, one of the phone drones suggested we send our last 1040 form. So we did, and that seem to satisfy them. Keep in mind this is all for income estimates anyway. The rubber meets the road when the IRS determines income eligibility and subsidies.

I know this is a first world problem but damn it was annoying.

There is no premium tax credit for folks under 100% of poverty income.  Officially, folks who are in this situation and have a jerk state legislature/governor don't get anything.  The way to play the game is to be "optimistic" about what one expects to earn in income that is that 100% + $1.  If someone gets a premium tax credit but ends up with an income that is below the 100%, he does not have to form over that credit.  How can anyone be penalized for not being a good prognosticator?

joshuagraham_xyz

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Re: What comes after the ACA?
« Reply #5885 on: February 23, 2020, 11:17:46 PM »
NY Times doesn't like me.  It won't let me read the article. 
Use Firefox, and click on the lock icon in the URL listbox, from which a dropdownlist will have an entry to allow you to remove cookies for the current website.  After doing that, wait a little while for a dialogbox to pop up which will show a listbox with all the cookies, from which you can delete them all.  After that refresh the page.  Voila!

joshuagraham_xyz

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Re: What comes after the ACA?
« Reply #5886 on: February 24, 2020, 01:21:18 AM »
The Supreme Court has refused to fast track the Obamacare case currently winding it's way through the court system.

https://www.politico.com/amp/news/2020/01/21/supreme-court-wont-review-obamacare-lawsuit-before-the-election-101356

I'm actually glad of this because despite the slightly decreased enrollment over the last couple years which is highly likely due to the Trump administration's halving of the open enrollment window and shrinking the budget for organizations to help people get enrolled by 90%, the actual healthcare markets themselves are in many places showing resiliency. Premiums have mostly stabilized and there are many markets where insurers are returning. I think a few more years of stabilization and proof that the law is working as intended will make it that much harder to kill.

Now if only we could get some action from the legislature that specifically addresses healthcare costs...

I'm actually not glad of it.  It's going to allow the republicans to wait until after the November election, in order to have most (or all) of the ACA killed by the court(s).

Yep. The conservative court is waiting until after the election for a reason.
Perhaps I'm not jaded enough yet but I don't think the Supreme Court is going to strip 10 million+ people of health insurance without any alternative. I suppose they could be bigger assholes than I imagine though.

There is no way that CJOTSCOTUS Roberts would agree to this ridiculous 5th Circuit decision.  However, it should be feared that AJOTSCOTUS Ginsberg doesn't make it, and Trump and a Republican Senate put up another AJOTSCOTUS.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5887 on: February 24, 2020, 07:19:11 AM »
As for myself, since I am fully Rothed out, my income is low enough to get the Medicaid expansion.

How were you able to get all your assets Rothed ?

Mr. Green

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Re: What comes after the ACA?
« Reply #5888 on: February 24, 2020, 12:18:26 PM »
The Supreme Court has refused to fast track the Obamacare case currently winding it's way through the court system.

https://www.politico.com/amp/news/2020/01/21/supreme-court-wont-review-obamacare-lawsuit-before-the-election-101356

I'm actually glad of this because despite the slightly decreased enrollment over the last couple years which is highly likely due to the Trump administration's halving of the open enrollment window and shrinking the budget for organizations to help people get enrolled by 90%, the actual healthcare markets themselves are in many places showing resiliency. Premiums have mostly stabilized and there are many markets where insurers are returning. I think a few more years of stabilization and proof that the law is working as intended will make it that much harder to kill.

Now if only we could get some action from the legislature that specifically addresses healthcare costs...

I'm actually not glad of it.  It's going to allow the republicans to wait until after the November election, in order to have most (or all) of the ACA killed by the court(s).

Yep. The conservative court is waiting until after the election for a reason.
Perhaps I'm not jaded enough yet but I don't think the Supreme Court is going to strip 10 million+ people of health insurance without any alternative. I suppose they could be bigger assholes than I imagine though.

There is no way that CJOTSCOTUS Roberts would agree to this ridiculous 5th Circuit decision.  However, it should be feared that AJOTSCOTUS Ginsberg doesn't make it, and Trump and a Republican Senate put up another AJOTSCOTUS.
It just seems like a short sighted play. The general public's concern for healthcare has only been growing. Republicans already failed to repeal and replace the ACA once. If the court system were to overturn it without Congress being able to replace it (which seems likely), I do believe the consequences for Republicans would be a blood bath in the next election. I don't understand why they want to poke that bear.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5889 on: February 24, 2020, 12:47:22 PM »
It just seems like a short sighted play. The general public's concern for healthcare has only been growing. Republicans already failed to repeal and replace the ACA once. If the court system were to overturn it without Congress being able to replace it (which seems likely), I do believe the consequences for Republicans would be a blood bath in the next election. I don't understand why they want to poke that bear.
On the contrary, I think Republicans might try to claim some deniability ("it wasn't us who killed it, and besides, it was unconstitutional!"), but either way, they'd be under a LOT of pressure to fill the gap.  If SCOTUS strikes down the ACA entirely, I find it hard to believe they wouldn't put a stay on the ruling for some period of time in order to allow Congress to come up with a replacement (or transition plan) of some sort.

The political trouble for the GOP is that an entitlement program like the ACA has immediate results, while a more market-driven cost reduction approach (which they would presumably champion) would take years to show gradual results.

sherr

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Re: What comes after the ACA?
« Reply #5890 on: February 24, 2020, 01:47:06 PM »
It just seems like a short sighted play. The general public's concern for healthcare has only been growing. Republicans already failed to repeal and replace the ACA once. If the court system were to overturn it without Congress being able to replace it (which seems likely), I do believe the consequences for Republicans would be a blood bath in the next election. I don't understand why they want to poke that bear.
On the contrary, I think Republicans might try to claim some deniability ("it wasn't us who killed it, and besides, it was unconstitutional!"), but either way, they'd be under a LOT of pressure to fill the gap. 

If they tried to claim that they would be obviously lying.

Given that
1) Republicans have been openly and eagerly and loudly attempting to kill the ACA since before it was law.
2) It's Republican states that are suing to have it declared unconstitutional.
3) It's Republican blatantly-partisan judges who are agreeing.
4) If it's declared unconstitutional, it's unconstitutional because of Republican legislation (the TCJA setting the uninsured penalty to $0, which makes it "not a tax", which makes the requirement to have insurance "unconstitutional", which "forces" the Judicial branch to strike down the entire law because that requirement is unseverable from the rest of it (instead of, you know, just deciding that the TCJA setting the penalty to $0 was the "unconstitutional" part)).

It's such a ridiculous argument I can't even bear to see it floated here without calling it out. If the ACA goes down its 10000% on the Republicans, and every single American knows it whether they'd be happy with its demise or not.

If SCOTUS strikes down the ACA entirely, I find it hard to believe they wouldn't put a stay on the ruling for some period of time in order to allow Congress to come up with a replacement (or transition plan) of some sort.

The political trouble for the GOP is that an entitlement program like the ACA has immediate results, while a more market-driven cost reduction approach (which they would presumably champion) would take years to show gradual results.

And which market-driven cost reduction approach would that be? Remember, the ACA is mostly "market-driven", which is why the Republicans haven't been able to come up with anything better in the last decade. They hate it because of who implemented it, not because of policy details.
« Last Edit: February 24, 2020, 02:08:56 PM by sherr »

bacchi

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Re: What comes after the ACA?
« Reply #5891 on: February 24, 2020, 02:03:32 PM »
And which market-driven cost reduction approach would that be? Remember, the ACA is mostly "market-driven", which is why the Republicans haven't been able to come up with anything better in the last decade. They hate it because of who implemented it, not because of policy details.

The Republican party has been working on an alternative plan for almost 10 years now. They'll release the details of that plan any day now.

</s>

American GenX

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Re: What comes after the ACA?
« Reply #5892 on: February 24, 2020, 03:54:14 PM »
The Supreme Court has refused to fast track the Obamacare case currently winding it's way through the court system.

I haven't seen anymore updates posted about this, but that's not been decided yet.

"The U.S. Supreme Court signaled it will use its Feb. 21 private conference to discuss whether to consider the fate of the Affordable Care Act on a fast-track schedule that would mean a decision by the end of June. "

https://thehill.com/policy/healthcare/481635-supreme-court-to-consider-taking-obamacare-case-at-feb-21-conference

"Democrats are urging the justices to hold arguments during the last week of April -- the court’s last scheduled week to hear cases -- or during a highly unusual special sitting in May."

https://www.bloomberglaw.com/document/X581H6QS000000

It takes 5 justices to vote for expediting the case this term.
It takes 4 justices to vote to take the case for review next term.
Otherwise, it continues back down to the district court regarding the severability of the mandate from the other components of the ACA, where it was previously ruled the entire law falls along with the mandate.

Just a follow-up on the above post.  They kicked the can down the road a little, so we don't know if they're going to take the case yet.

UPDATE: Feb. 24, 2020: The Supreme Court is now scheduled to review the ACA case during a conference date set for Friday, Feb. 28.

https://www.healthcaredive.com/news/supreme-court-mum-on-aca-case/572823/

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5893 on: February 24, 2020, 04:03:41 PM »
If they tried to claim that they would be obviously lying.
Oh, I'm not disagreeing with you there.
Quote
If SCOTUS strikes down the ACA entirely, I find it hard to believe they wouldn't put a stay on the ruling for some period of time in order to allow Congress to come up with a replacement (or transition plan) of some sort.

The political trouble for the GOP is that an entitlement program like the ACA has immediate results, while a more market-driven cost reduction approach (which they would presumably champion) would take years to show gradual results.

And which market-driven cost reduction approach would that be? Remember, the ACA is mostly "market-driven", which is why the Republicans haven't been able to come up with anything better in the last decade. They hate it because of who implemented it, not because of policy details.
I would argue that the tremendous amount of regulation surrounding health insurance moves it far, far away from "market-driven".

FWIW, I don't know anyone who opposes the ACA because it was Reid/Pelosi/Obama who passed it into law.  They oppose it for all sorts of reasons--moral hazard, increased regulation/red tape/barrier to entry, increased taxes, bureaucracy (just ask ExFlyBoy how his application is going), decreased choice, elimination of higher-efficiency (HDHP+FSA) options, losing their doctors or their plans, etc.  Personally, I see it as a gigantic, expensive bandaid that does nothing to address the root causes.  Instead of addressing questions like why our drug prices are so much higher than other countries', or why doctors command a higher salary (I heard 3x compared to Europe?), or what can be done to reduce overhead costs (e.g. the exceedingly complex world of medical billing), we've just layered on a heaping pile of government involvement.

The Republican party has been working on an alternative plan for almost 10 years now. They'll release the details of that plan any day now.
FWIW, they've tried several times, actually.  However, they've never had the filibuster-proof majority necessary in the Senate to get it passed.  And those attempts have gathered little media attention.

pecunia

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Re: What comes after the ACA?
« Reply #5894 on: February 24, 2020, 04:11:45 PM »
What attempts have the Republicans done to help health care?  I remember the ACHA which was to take health care from millions until the dying war hero John McCain cast the deciding vote to help us keep what little we have. 

I mean the Republicans are the guys that want to "reform" Social Security and Medicare and take stuff away from the elderly of this country.  Helping the sick just doesn't seem to be their thing.

If they were out to help the rest of us, why haven't we heard about it?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5895 on: February 24, 2020, 06:47:14 PM »
Personally, I see it as a gigantic, expensive bandaid that does nothing to address the root causes.  Instead of addressing questions like why our drug prices are so much higher than other countries', or why doctors command a higher salary (I heard 3x compared to Europe?), or what can be done to reduce overhead costs (e.g. the exceedingly complex world of medical billing), we've just layered on a heaping pile of government involvement.


Four government policies can effectively tackle the affordability issue.

1. "Despite a lot of talk about cutting drug prices, the Trump administration has taken no substantive action. Democrats need to endorse national, not just Medicare, drug price negotiations that use a value-based pricing framework — linking drug prices to their health benefits in reducing mortality and morbidity."

2. "hospital prices are soaring and must be contained. Medicare and Medicaid set their own hospital prices, which have risen modestly in recent years. But hospital prices for the roughly 160 million Americans with private insurance have shot up as much as drug prices. The main culprit behind this price escalation appears to be the mergers of hospital systems, which creates local monopolies.

3. "we need a policy that targets wasteful insurance billing practices. we spend nearly $500 billion a year on billing and insurance processing. empower an independent commission to create a clearinghouse for processing all medical bills with uniform standardized electronic formats for all insurers. Both Germany and Japan — countries with hundreds and thousands of insurance companies — have such centralized bill processing systems, generating low billing costs."

4. " push even harder on switching from fee-for-service payment to value-based alternatives. As it stands, when physicians avoid an unnecessary test or deliver the same outcomes for less money, they suffer financially. require every insurance company that receives any government funds — whether through Medicare, Medicaid, the insurance exchanges, Tricare or the federal employee insurance program — to require more than 50 percent of their payments to physicians be some kind of value-based payment within three years."

From "Democrats Are Having the Wrong Health Care Debate"
 https://nyti.ms/2YCwxSZ

American GenX

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Re: What comes after the ACA?
« Reply #5896 on: February 24, 2020, 07:05:32 PM »
2. "hospital prices are soaring and must be contained. Medicare and Medicaid set their own hospital prices, which have risen modestly in recent years. But hospital prices for the roughly 160 million Americans with private insurance have shot up as much as drug prices. The main culprit behind this price escalation appears to be the mergers of hospital systems, which creates local monopolies.

Yet many hospitals are hurting financially despite these price increases, are insufficiently reimbursed by Medicaid and Medicare, are cutting services, and many have closed completely.

https://www.beckershospitalreview.com/finance/21-hospital-closures-in-2018.html
https://www.msn.com/en-us/money/healthcare/why-us-hospitals-are-closing/ar-BBZLgWL
https://www.beckershospitalreview.com/finance/6-latest-hospital-bankruptcies-closures-01272020.html
https://www.wvlt.tv/content/news/568022311.html
https://www.beckershospitalreview.com/patient-flow/5-hospitals-closing-medical-units-halting-services.html

So, reimbursing them even less doesn't appear to be a solution to healthcare costs.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5897 on: February 25, 2020, 12:15:35 AM »
The Republican party has been working on an alternative plan for almost 10 years now. They'll release the details of that plan any day now.
FWIW, they've tried several times, actually.  However, they've never had the filibuster-proof majority necessary in the Senate to get it passed.  And those attempts have gathered little media attention.

I'm not aware of any substantive plan the Republicans have put forth other than repealing the ACA and returning us to the pre-ACA status quo. If such a plan does exist I'd certainly like to hear about it.

American GenX

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Re: What comes after the ACA?
« Reply #5898 on: February 25, 2020, 05:44:16 AM »
The Republican party has been working on an alternative plan for almost 10 years now. They'll release the details of that plan any day now.
FWIW, they've tried several times, actually.  However, they've never had the filibuster-proof majority necessary in the Senate to get it passed.  And those attempts have gathered little media attention.

I'm not aware of any substantive plan the Republicans have put forth other than repealing the ACA and returning us to the pre-ACA status quo. If such a plan does exist I'd certainly like to hear about it.

Just a stripped down version of the ACA that passed the house.  I know subsidies were less among other things in early steps to dismantle the law.

sherr

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Re: What comes after the ACA?
« Reply #5899 on: February 25, 2020, 07:52:28 AM »
The Republican party has been working on an alternative plan for almost 10 years now. They'll release the details of that plan any day now.
FWIW, they've tried several times, actually.  However, they've never had the filibuster-proof majority necessary in the Senate to get it passed.  And those attempts have gathered little media attention.

Complete nonsense. They held a few token votes during the Obama years, sure, but everyone knew it was all for show and that it wouldn't get anywhere. When Republicans actually held the trifecta of House / Senate / Presidency what did we get? A bunch of nothing, because they couldn't actually figure out an alternative that Republicans support.

Not having a "fillibuster-proof majority" is a complete red herring because they were using the budget reconciliation process as the avenue to introduce their health care plans, and budget reconciliation is inherently not fillibusterable. They didn't pass anything because they couldn't come up with a plan that could get majority support in a Republican-controlled Senate, no other reason.

The closest they got was the "repeal and don't replace" "plan" ("plan" being used in the loosest of ways here); that one went down by only one vote because there used to be one Republican who had moral qualms about screwing over the little guy.
« Last Edit: February 25, 2020, 08:01:33 AM by sherr »