What comes after the ACA?

[pecunia]

Not personally a "GOP member," but the other night at a town hall meeting in PA Trump said, in answer to a question from a person in the audience, that the prohibition against discrimination based on pre-existing conditions would NOT be eliminated, even if the ACA is overturned. Trump also said his administration was planning on *replacing* the ACA with a "great" new plan, although, of course, he was vague about what, exactly, said new plan would be. Pretty sure he doesn't know yet.

In 2017 Trump said they were going to come out with a "terrific" health care plan or some such.  They tried pushing the ACHA to replace the ACA.  It wasn't terrific.  Voters didn't like it.  Some say it is the reason Republicans no longer have the majority in the house.

I'm real cynical about anything the Republican boys promise.  As for Trump, you can't believe anything he says.  Just settle for Biden and maybe you'll get lucky.

[bacchi]

Not personally a "GOP member," but the other night at a town hall meeting in PA Trump said, in answer to a question from a person in the audience, that the prohibition against discrimination based on pre-existing conditions would NOT be eliminated, even if the ACA is overturned. Trump also said his administration was planning on *replacing* the ACA with a "great" new plan, although, of course, he was vague about what, exactly, said new plan would be. Pretty sure he doesn't know yet.

In 2017 Trump said they were going to come out with a "terrific" health care plan or some such.  They tried pushing the ACHA to replace the ACA.  It wasn't terrific.  Voters didn't like it.  Some say it is the reason Republicans no longer have the majority in the house.

I'm real cynical about anything the Republican boys promise.  As for Trump, you can't believe anything he says.  Just settle for Biden and maybe you'll get lucky.

On July 17th, there was going to be a plan in 2 weeks.
On July 31st, there was going to be a very inclusive plan very soon now.

It's a carrot tied to the end of a stick.

[rantk81]

I did look into what the ACHA was about.  It was very similar to the ACA, but there were some key differences, with a no-doubt conservative slant:

- Allowed States to apply for waivers so that plans didn't have to cover certain things to meet "Minimum Essential Care".. (e.g. Red states don't want plans to cover mental health or many gender-specific procedures.)
- Kept premium subsidies -- and made them available to folks with higher incomes -- but the subsidies were less generous overall.
- Allowed for insurance companies to charge higher premiums for older people and people with pre-existing conditions (but still with a cap - albeit higher....)
- Removed cost sharing subsidies (this would be a HUGE problem for low income families -- where an OOPMAX could be greater than their annual income!)
- Eliminate individual mandate
- Pulled back on the expansion of Medicaid.

Not exactly earth shatteringly different as  "repeal and replace" was espoused about.... But also IMO certainly not making the ACA "better" in any tangible way either.

[talltexan]

Thanks for this study, @rantk81

[rantk81]

Thanks for this study, @rantk81

Yep!  If I'm missing (or mis-representing something?) please someone chime in.  I didn't actually read the bill -- I just read a few (what I hoped were) non-partisan articles on it.

The funny thing is -- from what I've seen -- ACA and AHCA are probably similar enough that, if American politics weren't so polarized (or if the politicians didn't want to continue to use Obamacare as a rallying cry?), I think there is a LOT of room for a compromise!

[jim555]

If you go back in this thread you will see detailed discussion of the crappy Repub proposals.  They do stuff like keep Medicaid expansion, but cut the Federal match from 90% to 50%, which means no state can afford it so it ends it.  Then they do subsidies, but they are not indexed to anything so that over time they get lower and lower, again crapola.  They also do barely minimal coverage so you end up pay most of the bill out of pocket.

[rantk81]

Yeah that’s pretty crappy and sounds like an intentional phase out of the whole thing. Garbage.

[Malloy]

I did look into what the ACHA was about.  It was very similar to the ACA, but there were some key differences, with a no-doubt conservative slant:

- Allowed States to apply for waivers so that plans didn't have to cover certain things to meet "Minimum Essential Care".. (e.g. Red states don't want plans to cover mental health or many gender-specific procedures.)
- Kept premium subsidies -- and made them available to folks with higher incomes -- but the subsidies were less generous overall.
- Allowed for insurance companies to charge higher premiums for older people and people with pre-existing conditions (but still with a cap - albeit higher....)
- Removed cost sharing subsidies (this would be a HUGE problem for low income families -- where an OOPMAX could be greater than their annual income!)
- Eliminate individual mandate
- Pulled back on the expansion of Medicaid.

Not exactly earth shatteringly different as  "repeal and replace" was espoused about.... But also IMO certainly not making the ACA "better" in any tangible way either.

Gender-specific procedures include mandated pregnancy coverage under the ACA, by the way. I'm old enough to remember pregnancy riders in private insurance before the ACA.  It was extremely common for insurance plans not to cover pregnancy, and the pregnancy riders were on the order of 10k/year.  The ACA put pregnancy and childbirth on its list of things insurance plans have to cover. It's a good thing.   

People-I'd like to retire early.  Please vote to preserve the ACA in November (for those not paying attention, that means not voting for Trump).  If the ACA disappears, Trump's "great" coverage for pre-existing conditions is going to be as real as the checks coming from Mexico to pay for the wall.  If the ACA goes down, that's it.  Pre-existing condition exclusions are back on the menu.  And we'll have no way of covering ourselves until Medicare kicks in.  Not just me, but all of us.  The ACA is the biggest early retirement boon out there.

[MrGreen]

I did look into what the ACHA was about.  It was very similar to the ACA, but there were some key differences, with a no-doubt conservative slant:

- Allowed States to apply for waivers so that plans didn't have to cover certain things to meet "Minimum Essential Care".. (e.g. Red states don't want plans to cover mental health or many gender-specific procedures.)
- Kept premium subsidies -- and made them available to folks with higher incomes -- but the subsidies were less generous overall.
- Allowed for insurance companies to charge higher premiums for older people and people with pre-existing conditions (but still with a cap - albeit higher....)
- Removed cost sharing subsidies (this would be a HUGE problem for low income families -- where an OOPMAX could be greater than their annual income!)
- Eliminate individual mandate
- Pulled back on the expansion of Medicaid.

Not exactly earth shatteringly different as  "repeal and replace" was espoused about.... But also IMO certainly not making the ACA "better" in any tangible way either.

Gender-specific procedures include mandated pregnancy coverage under the ACA, by the way. I'm old enough to remember pregnancy riders in private insurance before the ACA.  It was extremely common for insurance plans not to cover pregnancy, and the pregnancy riders were on the order of 10k/year.  The ACA put pregnancy and childbirth on its list of things insurance plans have to cover. It's a good thing.   

People-I'd like to retire early.  Please vote to preserve the ACA in November (for those not paying attention, that means not voting for Trump).  If the ACA disappears, Trump's "great" coverage for pre-existing conditions is going to be as real as the checks coming from Mexico to pay for the wall.  If the ACA goes down, that's it.  Pre-existing condition exclusions are back on the menu.  And we'll have no way of covering ourselves until Medicare kicks in.  Not just me, but all of us.  The ACA is the biggest early retirement boon out there.

Not just early retirement, but anyone who wants to start a business as well. It's a great way to keep the masses in line through "forced" early. It's a great way to keep business ownership in the hands of rich people.

[pecunia]

Voting - It ain't just Trump.  It takes the Senate and House to change American medicine for the better.  These guys have to be hounded until they start to make positive changes.

[American GenX]

Preserve the ACA in November (for those not paying attention, that means not voting for Trump).  If the ACA disappears, Trump's "great" coverage for pre-existing conditions is going to be as real as the checks coming from Mexico to pay for the wall.  If the ACA goes down, that's it.  Pre-existing condition exclusions are back on the menu.  And we'll have no way of covering ourselves until Medicare kicks in.  Not just me, but all of us.  The ACA is the biggest early retirement boon out there.

Actually, the Supreme Court will hear the case in November, and even if Biden is president in January, it will be out of his hands if the Supreme Court overturns the ACA, which is certainly more likely now, or with a tie, send it back to the lower court which has already ruled it unconstitutional.  But having said that, it makes a lot more sense to vote for Biden for president and democrats for Congress if you care at all about health care coverage.  Biden can't do it on his own.  If the ACA is to be ruled unconstitutional because of the no-penalty mandate, the dems could reinstate the penalty, or they might actually come out with something decent to replace the ACA.  If the ACA stays, they may actually improve or expand on it.  With Trump, you are SOL.

[jpdx]

I was thinking the same thing. RBG's death could set off a chain of events which provides the impetus for congress to make improvements to the ACA. There are some things that can be improved through budget reconciliation. But for this to happen, Biden needs to win and Dems need to control the Senate.

[AdrianC]

3. Move to Canada/UK/etc.

Or a blue state? Massachusetts had RomneyCare before the ACA. I presume they'll go back to that, or something even more socialist, and many other states will do something similar.

Wasn't RomnneyCare a failure? I thought it ended in a death spiral?
I also seem to remember that private health insurance wasn't really doable in some blue states - New York, maybe?

Moving to a blue state is an option.

We bought health insurance in Ohio for years prior to the ACA. No issues, but always with that danger that they'll drop us just when we need it. Or jack the rates up.

On my bike ride yesterday I came to the conclusion that my wife and I need to plan for the ACA going away with no replacement. There's a good chance that we will not be able to buy health insurance come 2022. I assume 2021 plans will be available and the Supreme Court will allow them to continue to give the politicians time to come up with a replacement, which they will not do.

This means one of us needs to find a gig that provides group health insurance for the family. Something useful, satisfying, and that doesn't take up too much time. Any ideas?

[SauronHimself]

This means one of us needs to find a gig that provides group health insurance for the family. Something useful, satisfying, and that doesn't take up too much time. Any ideas?

Starbucks still offers health insurance if you work 20 hours per week, so it's useful in the sense you can acquire the benefit via minimal effort. Plus, I'm sure the employees get a lot of free coffee. Its satisfaction may depend on whether you enjoy talking to people.

[rantk81]

This means one of us needs to find a gig that provides group health insurance for the family. Something useful, satisfying, and that doesn't take up too much time. Any ideas?

Starbucks still offers health insurance if you work 20 hours per week, so it's useful in the sense you can acquire the benefit via minimal effort. Plus, I'm sure the employees get a lot of free coffee. Its satisfaction may depend on whether you enjoy talking to people.

Makes "Barista FIRE" a bit more literal....

[AdrianC]

This means one of us needs to find a gig that provides group health insurance for the family. Something useful, satisfying, and that doesn't take up too much time. Any ideas?

Starbucks still offers health insurance if you work 20 hours per week, so it's useful in the sense you can acquire the benefit via minimal effort. Plus, I'm sure the employees get a lot of free coffee. Its satisfaction may depend on whether you enjoy talking to people.

Thanks. I love coffee, but I make it at home. Selling coffee in disposable cups would be very much not satisfying to me.

I'm thinking more like a charity, school, or similar. It doesn't need to pay hardly anything. Mrs C has volunteered at our local school for years. A teacher's aid job is a possibility. She's not sold on the idea...

[jim555]

3. Move to Canada/UK/etc.

Or a blue state? Massachusetts had RomneyCare before the ACA. I presume they'll go back to that, or something even more socialist, and many other states will do something similar.

Wasn't RomnneyCare a failure? I thought it ended in a death spiral?
I also seem to remember that private health insurance wasn't really doable in some blue states - New York, maybe?

Moving to a blue state is an option.

No blue state can afford anything like the ACA, it would break their budgets.  The amount of taxes required simply would not be tolerated, and it would place those states at a competitive disadvantage.  Practical reality is any solution needs to come Federally.

[pecunia]

How much will this affect the upcoming election?

Trump's base is supposed to be a solid 38 percent.  The voter turnout is around 53 percent.  This means about .53 X 329 million will vote.  This number is 174.4 million.

Let's figure all Trump's people vote. Thirty eight percent of 174.4 million is 66.26. million.

Now let's figure that all the people who benefited from the ACA will be smart enough to vote in their own interests.

Article on ACA - https://policyadvice.net/health-insurance/insights/affordable-care-act-statistics/

Excerpt from article: "In 2017, 73.8 million people were enrolled in the ACA-based Medicaid insurance program."

Of course only 53 percent or so will actually vote - So this is 39.1 million people.

So this 39.1 million versus Trump's base of 66.26 million.

If people think like me and consider health care to be something worth voting for, it could be a major factor in the election.  Of course, they have to be made to realize that their health care could be determined by who they vote for.  You would think it would be on people's minds with the Covid thing, but people may not link Covid with their health insurance.

Actual numbers will of course vary.

[Malloy]

This means one of us needs to find a gig that provides group health insurance for the family. Something useful, satisfying, and that doesn't take up too much time. Any ideas?

Starbucks still offers health insurance if you work 20 hours per week, so it's useful in the sense you can acquire the benefit via minimal effort. Plus, I'm sure the employees get a lot of free coffee. Its satisfaction may depend on whether you enjoy talking to people.

Thanks. I love coffee, but I make it at home. Selling coffee in disposable cups would be very much not satisfying to me.

I'm thinking more like a charity, school, or similar. It doesn't need to pay hardly anything. Mrs C has volunteered at our local school for years. A teacher's aid job is a possibility. She's not sold on the idea...

I'm thinking the same sort of thing, but I'd MUCH rather have access to the ACA and not have to worry about showing up somewhere 15 hours a week when I'm supposed to be retired.  Plus, it's actually pretty hard to get hired in your 50s because older people are expensive to insure.  That's unchanged pre and post ACA.

My plan is to spend some time now convincing people to get out and vote Republicans out of office, and I'm hoping that the effort will save me those 15 hours a week in the future.  It seems like a good trade off.  The best and most persuasive argument I've found is that covid-19 infection is going to be a preexisting condition likely excluding cardiac and lung coverage if the ACA goes away.  Do you really want to get into it with the insurance companies about whether they cover your cardiac care in your 50s because you had covid?
 

[wenchsenior]

How much will this affect the upcoming election?

Trump's base is supposed to be a solid 38 percent.  The voter turnout is around 53 percent.  This means about .53 X 329 million will vote.  This number is 174.4 million.

Let's figure all Trump's people vote. Thirty eight percent of 174.4 million is 66.26. million.

Now let's figure that all the people who benefited from the ACA will be smart enough to vote in their own interests.

Article on ACA - https://policyadvice.net/health-insurance/insights/affordable-care-act-statistics/

Excerpt from article: "In 2017, 73.8 million people were enrolled in the ACA-based Medicaid insurance program."

Of course only 53 percent or so will actually vote - So this is 39.1 million people.

So this 39.1 million versus Trump's base of 66.26 million.

If people think like me and consider health care to be something worth voting for, it could be a major factor in the election.  Of course, they have to be made to realize that their health care could be determined by who they vote for.  You would think it would be on people's minds with the Covid thing, but people may not link Covid with their health insurance.

Actual numbers will of course vary.

I'm not sure 'smart enough' is exactly how I'd frame it, but answer is almost certainly no, they won't.  There was an incredible series of articles run (can't remember, maybe by Vox or Slate) after KY enacted the Medicaid expansion and the ACA, where journalists went and interviewed tons of people (many with serious health conditions) who were newly insured.  Many of them still supported the GOP, even though Trump was actively running on taking away the ACA.  Reasons  ranged from "It pisses me off that other people who deserve it less than I do are also getting this health care" to the fact that voting against Trump in KY would put them at odds with their family/social group, for nothing (b/c KY always goes red anyway), to "immigration/guns/abortion/etc is more important", to simply not believing the GOP would ACTUALLY take health insurance away.

So I would not count on health care to swing that many formerly Trump supporting voters.

[Omy]

I did look into what the ACHA was about.  It was very similar to the ACA, but there were some key differences, with a no-doubt conservative slant:

- Allowed States to apply for waivers so that plans didn't have to cover certain things to meet "Minimum Essential Care".. (e.g. Red states don't want plans to cover mental health or many gender-specific procedures.)
- Kept premium subsidies -- and made them available to folks with higher incomes -- but the subsidies were less generous overall.
- Allowed for insurance companies to charge higher premiums for older people and people with pre-existing conditions (but still with a cap - albeit higher....)
- Removed cost sharing subsidies (this would be a HUGE problem for low income families -- where an OOPMAX could be greater than their annual income!)
- Eliminate individual mandate
- Pulled back on the expansion of Medicaid.

Not exactly earth shatteringly different as  "repeal and replace" was espoused about.... But also IMO certainly not making the ACA "better" in any tangible way either.

Gender-specific procedures include mandated pregnancy coverage under the ACA, by the way. I'm old enough to remember pregnancy riders in private insurance before the ACA.  It was extremely common for insurance plans not to cover pregnancy, and the pregnancy riders were on the order of 10k/year.  The ACA put pregnancy and childbirth on its list of things insurance plans have to cover. It's a good thing.   

People-I'd like to retire early.  Please vote to preserve the ACA in November (for those not paying attention, that means not voting for Trump).  If the ACA disappears, Trump's "great" coverage for pre-existing conditions is going to be as real as the checks coming from Mexico to pay for the wall.  If the ACA goes down, that's it.  Pre-existing condition exclusions are back on the menu.  And we'll have no way of covering ourselves until Medicare kicks in.  Not just me, but all of us.  The ACA is the biggest early retirement boon out there.

100% this. I have been self employed most of my adult life and had to purchase individual policies with inadequate coverage until the ACA. As a 26 year old I was excluded for pregnancy/csection without having any pre-existing condition...they just didn't want to pay for a pregnancy. In my 30s, my insurance kept going up any time I went to the doctor. One year my premium increased on THREE different occasions. Imagine having no idea what your premium is going to be...just because you go in for preventative care. In my 40s I was able to call myself a group of 1 and that meant that as long as I was working my premium would be guaranteed for the whole year BUT if I got too sick to work, I would be dumped from the insurance the following year. And if I had a million dollar health issue I would be uninsurable for life since I had hit the lifetime cap. And pre-existing conditions could be excluded or could jack up your rates to impossible numbers. The ACA has added so much peace of mind since none of these things can happen to you any longer.

Improving the ACA...or Medicare for all...or something better needs to happen. We will go back to inadequate coverage and uncontrollable premiums if Trump and the GOP have their way.

[bacchi]

Decent worldwide health insurance plans are actually pretty inexpensive. They even have a lower deductible than our ACA plan, which admittedly isn't that hard to do.

[rantk81]

Decent worldwide health insurance plans are actually pretty inexpensive. They even have a lower deductible than our ACA plan, which admittedly isn't that hard to do.

Yeah, but if they deny your large claims -- which appeals board or court is going to hold them to the terms of the contracts? :)

[bacchi]

Decent worldwide health insurance plans are actually pretty inexpensive. They even have a lower deductible than our ACA plan, which admittedly isn't that hard to do.

Yeah, but if they deny your large claims -- which appeals board or court is going to hold them to the terms of the contracts? :)

No worse than pre-ACA America, when insurance company employees earned bonuses for rescinds.

Unfortunately, the alternative for most of us is to go back to work. It's silly to think of a bunch of millionaires working at Starbucks 20 hours/week just to get health insurance. I guess we should've saved...$5 million to self-insure?

[friedmmj]

Aren’t  401k and IRA assets beyond the reach of creditors?  If so then one option is to self insure and if there is a catastrophic claim then declare bankruptcy.

[Luck12]

My backup plan was to move to the state of Washington.  They locked in all of the important ACA provisions.  Hopefully someone from WA can comment on this. 

Volunteer, exhort, etc to make sure we get at least 50 Democratic senators. People's lives (health wise and financially) depend on it!

http://acasignups.net/19/04/17/washington-gov-inslee-signs-bill-fully-locking-blue-leg-protections

[Exflyboy]

Aren’t  401k and IRA assets beyond the reach of creditors?  If so then one option is to self insure and if there is a catastrophic claim then declare bankruptcy.

IRA assets.. Not in all States are they protected.

What if a significant portion of your assets are held in after tax brokerage accounts?..

[DaMa]

Decent worldwide health insurance plans are actually pretty inexpensive. They even have a lower deductible than our ACA plan, which admittedly isn't that hard to do.

Don't most worldwide health insurance plans specifically exclude claims in the US?

[bacchi]

Decent worldwide health insurance plans are actually pretty inexpensive. They even have a lower deductible than our ACA plan, which admittedly isn't that hard to do.

Don't most worldwide health insurance plans specifically exclude claims in the US?

Yes. That's what makes them so reasonably priced. :)

[pecunia]

Decent worldwide health insurance plans are actually pretty inexpensive. They even have a lower deductible than our ACA plan, which admittedly isn't that hard to do.

Don't most worldwide health insurance plans specifically exclude claims in the US?

Yes. That's what makes them so reasonably priced. :)

So - If one lived close to the border, could you buy that worldwide insurance and just drive North across the border for healthcare?

[Trudie]

Our state (Iowa) offers fuck all for ACA plans.  When COBRA expires we’re purchasing on the open market.  An HDHP for $1400 per month.  And these are the group rates.  Still, at least we can get something. 

Exploring Washington State as a Plan B. 

[former player]

Decent worldwide health insurance plans are actually pretty inexpensive. They even have a lower deductible than our ACA plan, which admittedly isn't that hard to do.

Don't most worldwide health insurance plans specifically exclude claims in the US?

Yes. That's what makes them so reasonably priced. :)

So - If one lived close to the border, could you buy that worldwide insurance and just drive North across the border for healthcare?

Not if the border you are close to is Canada's.

(Also, I think you will find an exclusion clause somewhere in the policy.)

[rab-bit]

File this under: "if you can't laugh then you'll cry".

I was reading news about the future of the ACA when I came across this article announcing that my state (Pennsylvania) will launch its own health insurance marketplace on November 1:

https://pittsburgh.cbslocal.com/2020/09/22/pennsylvania-health-insurance-website/

"Gov. Tom Wolf’s administration has said it expects it can lower premiums by 5% to 10% for the roughly 400,000 people who have been buying policies in the Healthcare.gov marketplace."

[rantk81]

I was reading news about the future of the ACA when I came across this article announcing that my state (Pennsylvania) will launch its own health insurance marketplace on November 1:

I think several other states already do this....

[pecunia]

Some big political problems become big issues for a while and then die out.  Things return to the status quo.  Is this one of them?  If the law is largely unaffected in the Supreme Court, can Congress simply ignore this law for a few years and put it on the far back burner?  Then, the health industry can slowly take it apart piece by piece over a few years.  It kind of looks like that's happening.  They can't cut the dogs tail off all at once so they are doing it a piece at a time.

[rab-bit]

I was reading news about the future of the ACA when I came across this article announcing that my state (Pennsylvania) will launch its own health insurance marketplace on November 1:

I think several other states already do this....

Yes, several states already do this, it's just the timing of it that has me hitting my head against the wall. PA finally gets around to establishing its own marketplace, with it going live just as the ACA is increasingly likely to disappear.

[EscapeVelocity2020]

Listening to Dr. Fauci and Dr. Redfield's testimony to the Senate, this gem stands out.  Up to 60 - 70% of individuals with even mild or asymptomatic cases show inflammation of the heart.  This could lead to scarring and arrhythmias down the road, but this won't be known for several years.  So basically, having tested positive for Covid could qualify as having a pre-existing condition...

[Exflyboy]

Listening to Dr. Fauci and Dr. Redfield's testimony to the Senate, this gem stands out.  Up to 60 - 70% of individuals with even mild or asymptomatic cases show inflammation of the heart.  This could lead to scarring and arrhythmias down the road, but this won't be known for several years.  So basically, having tested positive for Covid could qualify as having a pre-existing condition...

Could?.. Thats exactly what will happen!

[SugarMountain]

File this under: "if you can't laugh then you'll cry".

I was reading news about the future of the ACA when I came across this article announcing that my state (Pennsylvania) will launch its own health insurance marketplace on November 1:

https://pittsburgh.cbslocal.com/2020/09/22/pennsylvania-health-insurance-website/

"Gov. Tom Wolf’s administration has said it expects it can lower premiums by 5% to 10% for the roughly 400,000 people who have been buying policies in the Healthcare.gov marketplace."

I don't think states having their own marketplace makes it any cheaper. Colorado has its own and it's very expensive here. Or will
it prevent insurers from denying new customers due to pre-existing conditions if the ACA gets thrown out. It will be up to states to do their own laws to replace the ACA. Now it is possible that the Democrats retake the presidency and Senate and pass a new law to replace the ACA. The sticky bit is and always will be the mandate. Without the mandate, insurers don't want to cover people with pre-existing conditions. Now it has survived even without the mandate up until now, but with a 6-3 conservative court I won't be surprised if the whole thing gets thrown out. I think insurers have just been keeping their powder dry for now. (Although, it may actually be that the subsidies provide them with enough extra revenue they would prefer the ACA survive. Just look at $UNH since the ACA passed.)

[Paul der Krake]

They are probably referring to the reinsurance program that PA is about to launch.

[rab-bit]

They are probably referring to the reinsurance program that PA is about to launch.

I  think you're right. From another article (https://www.meadvilletribune.com/news/pennsylvania-launches-new-state-run-aca-marketplace/article_2e986e20-fe95-5e70-9cab-3c3cf9bd0810.html):

"The move to launch a state-run marketplace at pennie.com was spurred by a 2019 state law. State officials believe that the state will be able to run its marketplace at lower cost than the federal government does, Altman said.

The savings left over because the state operates the marketplace will then be used to funded a reinsurance program that subsidizes the cost of insurance to lower premiums she said."

[stoaX]

File this under: "if you can't laugh then you'll cry".

I was reading news about the future of the ACA when I came across this article announcing that my state (Pennsylvania) will launch its own health insurance marketplace on November 1:

https://pittsburgh.cbslocal.com/2020/09/22/pennsylvania-health-insurance-website/

"Gov. Tom Wolf’s administration has said it expects it can lower premiums by 5% to 10% for the roughly 400,000 people who have been buying policies in the Healthcare.gov marketplace."

I don't think states having their own marketplace makes it any cheaper. Colorado has its own and it's very expensive here. Or will
it prevent insurers from denying new customers due to pre-existing conditions if the ACA gets thrown out. It will be up to states to do their own laws to replace the ACA. Now it is possible that the Democrats retake the presidency and Senate and pass a new law to replace the ACA. The sticky bit is and always will be the mandate. Without the mandate, insurers don't want to cover people with pre-existing conditions. Now it has survived even without the mandate up until now, but with a 6-3 conservative court I won't be surprised if the whole thing gets thrown out. I think insurers have just been keeping their powder dry for now. (Although, it may actually be that the subsidies provide them with enough extra revenue they would prefer the ACA survive. Just look at $UNH since the ACA passed.)

Retired health insurance underwriter here.  I can confirm that you are correct. The company I used to work for used the same methodology for determining ACA rates regardless of whether the location was in a state with their own exchange or if the federal exchange was used.

[rab-bit]

File this under: "if you can't laugh then you'll cry".

I was reading news about the future of the ACA when I came across this article announcing that my state (Pennsylvania) will launch its own health insurance marketplace on November 1:

https://pittsburgh.cbslocal.com/2020/09/22/pennsylvania-health-insurance-website/

"Gov. Tom Wolf’s administration has said it expects it can lower premiums by 5% to 10% for the roughly 400,000 people who have been buying policies in the Healthcare.gov marketplace."

I don't think states having their own marketplace makes it any cheaper. Colorado has its own and it's very expensive here. Or will
it prevent insurers from denying new customers due to pre-existing conditions if the ACA gets thrown out. It will be up to states to do their own laws to replace the ACA. Now it is possible that the Democrats retake the presidency and Senate and pass a new law to replace the ACA. The sticky bit is and always will be the mandate. Without the mandate, insurers don't want to cover people with pre-existing conditions. Now it has survived even without the mandate up until now, but with a 6-3 conservative court I won't be surprised if the whole thing gets thrown out. I think insurers have just been keeping their powder dry for now. (Although, it may actually be that the subsidies provide them with enough extra revenue they would prefer the ACA survive. Just look at $UNH since the ACA passed.)

Retired health insurance underwriter here.  I can confirm that you are correct. The company I used to work for used the same methodology for determining ACA rates regardless of whether the location was in a state with their own exchange or if the federal exchange was used.

The idea is that the state will partially subsidize premiums through a reinsurance program: https://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg2704654/#msg2704654

Additional details: https://www.governor.pa.gov/newsroom/gov-wolf-reinsurance-program-application-receives-federal-approval/

Anyway, it may all be for nothing if the ACA is struck down by SCOTUS.

[Omy]

We can all rest easy...Trump is going to fix the healthcare system with a couple of executive orders.

[Exflyboy]

We can all rest easy...Trump is going to fix the healthcare system with a couple of executive orders.

The scary thing is the number of people stupid enough to believe that got him elected last time.. I'm not convinced he won't be elected this November either!

[dresden]

Here's an article from Bloomberg suggesting that Kavanaugh and even Alito might vote to sever the tax penalty and leave the rest of the law intact.  The article also notes that the decision will not be rendered until some time in early 2021.  Should the Democrats take the White House and Senate, a legislative fix could moot the whole matter before anyone actually loses their health insurance.

https://www.msn.com/en-us/news/politics/ginsburg-s-death-injects-new-doubt-into-fate-of-obamacare/ar-BB19fvX2

I am independent in Florida that has voted for both parties in the past based on who I thought was the best candidate.  This is an issue that might make me never vote for a republican again.

[DavidAnnArbor]

I keep asking Republicans I know in Michigan who depend on either Medicaid or the Marketplace what are they going to do if these get repealed?  I get magical thinking type answers.

[Shane]

I keep asking Republicans I know in Michigan who depend on either Medicaid or the Marketplace what are they going to do if these get repealed?  I get magical thinking type answers.

My understanding is that any changes won't happen until at least 2022. Given that we don't know who is going to be in the WH after January 20, 2021, and we don't know who will control the House and Senate, it's pretty hard to answer that question. I'm choosing to just chill and enjoy my life now, with the ACA. If things change, we'll adapt.

[pecunia]

I keep asking Republicans I know in Michigan who depend on either Medicaid or the Marketplace what are they going to do if these get repealed?  I get magical thinking type answers.

Well - They'll do what they always do.  They will blame the Democrats.  Specifically, they will blame Obama.  It was his law, after all.

I wonder how Lincoln would handle the nation's health care system in these times:

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan—to do all which may achieve and cherish a just, and a lasting peace, among ourselves, and with all nations."

Is history right in calling him a Republican?  Hr just doesn't sound like a Republican.

[sherr]

I keep asking Republicans I know in Michigan who depend on either Medicaid or the Marketplace what are they going to do if these get repealed?  I get magical thinking type answers.

Well - They'll do what they always do.  They will blame the Democrats.  Specifically, they will blame Obama.  It was his law, after all.

I wonder how Lincoln would handle the nation's health care system in these times:

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan—to do all which may achieve and cherish a just, and a lasting peace, among ourselves, and with all nations."

Is history right in calling him a Republican?  Hr just doesn't sound like a Republican.

The Republican party through Eisenhower was a very different thing from what it is now. Nixon changed the morals of it, and Reagan changed the economics of it. I wish we had the old one back.