Author Topic: What comes after the ACA?  (Read 1393974 times)

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6150 on: September 21, 2020, 05:00:37 AM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406
Good article.

If a decision is unfavourable it seems like the ACA will still be in place for 2021 and possibly 2222.
From reading various articles they would need to agree that the portion of the law in the suit is unconstitutional and the law is not severable.  Since Congress already altered the ACA with the CARES act just recently, and they did it with a $0 penalty in place, then they set a legal precedent.  The argument that the entire law needs to be thrown out because the individual mandate is integral to the law can no longer be made, since Congress altered the law with no individual mandate in place.  Worst case is only parts of the law concerning pre-existing conditions gets thrown out, but other parts stay, like subsidies and the Medicaid expansion.  Post election Congress can fix whatever needs fixing, with the right people in charge.

There are plenty of constitutional law experts, including many known as conservative, who think the pending case is a farce and shouldn't have made it as far as it did.

The fact that it's before the SC means that what is lawful doesn't matter. If the cultural wars demand it, the conservative Justices will get rid of it and make up a rationale why, even if the reasoning is held together with twine and tape.

I think that's true of Thomas and Alito, who always vote the Republican party line, legal rationale be damned.  That isn't true of Roberts, who has shown a willingness to break with the conservative bloc on a few consequential decisions (including two previous votes to uphold the ACA).  After the LGBTQ discrimination decision, I have hope that maybe Gorsuch will also rule according to the law instead of ideology.  Kavanaugh is a wild card at this point, so I think we have to assume he will toe the party line.  If I am right, this situation would produce a 5-vote majority for upholding the ACA.

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

talltexan

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Re: What comes after the ACA?
« Reply #6151 on: September 21, 2020, 06:08:05 AM »
I'm not sure if the Republican party would survive some of their legislative priorities actually being passed into law and upheld. A lot of it is only popular within the party (ie making abortion totally illegal), and a lot only popular in the abstract (ie, ACA repeal). From the standpoint of the party, if we're cynical about the motivations of politicians, they're better off running against the same things every year than they are actually getting those things annulled and then having to deal with the fallout. 

-W

It's obvious that there are many--perhaps twenty--states where Republicans will maintain power exactly by doing these things. And we are a confederation of states (the Senate and the Electoral College both reflect that). So as long as Republicans are making these priorities into law at the state level, only the Supreme Court would be able to moderate this.

rantk81

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Re: What comes after the ACA?
« Reply #6152 on: September 21, 2020, 11:48:09 AM »
Circling back to the ACA topic (and maybe presuming that republicans get their way and having it "Thrown away") ...
I have questions, and I am being very serious - because I don't know the answer for it.  The ACA provided certain things. What is the Republican's proposed way of replacing these features or modifying the law to improve the situation?

ACA provides a "market place" where you can find plans, in every single state.
ACA dictates to insurance companies that if they want to provide a plan on the exchange, they cannot turn people away or charge them more for having existing medical conditions.
ACA provides for very low income people to have Medicaid at < 138% FPL.  (Unless a State specifically opts out of it. This "choice" is only a thing because of Republican arguments.)
ACA provides for low income people (138FPL to 400FPL) to receive a discount/subsidy on buying insurance, which caps expenses to a reasonable percentage of their income.

Which pieces of that are the Republicans wanting to remove?  And replace with what?

I never ever ever hear any concrete answers, except Trump hating on it because the name it is often referred to bears Obama's name.

Please, if any GOP members are here, enlighten me on what the grand plans are for ensuring everyone can get coverage at a price level that is capped relative to their income (e.g. "affordable.")

Or is the complaint that it is "Too expensive" to try to cover everyone, so we should just expect the sick and poor to not get care?
« Last Edit: September 21, 2020, 12:14:34 PM by rantk81 »

Shane

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Re: What comes after the ACA?
« Reply #6153 on: September 21, 2020, 12:09:03 PM »
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.

sherr

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Re: What comes after the ACA?
« Reply #6154 on: September 21, 2020, 12:20:44 PM »
Which pieces of that are the Republicans wanting to remove?  And replace with what?

All of it, with vague promises to keep the pre-existing-conditions clause "somehow".

Don't worry, they'll figure out the details of what will be in their healthcare bill "after the election". It's not like they've already had a decade to do that and are still coming up empty-handed, or anything. It's not like they already proved they they don't have any viable alternatives in Trump's second year, or anything.

pecunia

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Re: What comes after the ACA?
« Reply #6155 on: September 21, 2020, 01:13:16 PM »
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

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Re: What comes after the ACA?
« Reply #6156 on: September 21, 2020, 01:46:11 PM »
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

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Re: What comes after the ACA?
« Reply #6157 on: September 21, 2020, 01:57:17 PM »
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.

« Last Edit: September 21, 2020, 02:11:47 PM by rantk81 »

talltexan

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Re: What comes after the ACA?
« Reply #6158 on: September 21, 2020, 03:07:50 PM »
Thanks for this study, @rantk81

rantk81

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Re: What comes after the ACA?
« Reply #6159 on: September 21, 2020, 03:26:44 PM »
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!
« Last Edit: September 21, 2020, 03:31:05 PM by rantk81 »

jim555

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Re: What comes after the ACA?
« Reply #6160 on: September 21, 2020, 04:28:05 PM »
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

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Re: What comes after the ACA?
« Reply #6161 on: September 21, 2020, 05:01:35 PM »
Yeah that’s pretty crappy and sounds like an intentional phase out of the whole thing. Garbage.

Malloy

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Re: What comes after the ACA?
« Reply #6162 on: September 21, 2020, 08:34:55 PM »
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.

Mr. Green

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Re: What comes after the ACA?
« Reply #6163 on: September 21, 2020, 09:10:13 PM »
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

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Re: What comes after the ACA?
« Reply #6164 on: September 21, 2020, 09:12:14 PM »
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

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Re: What comes after the ACA?
« Reply #6165 on: September 21, 2020, 09:53:56 PM »
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.
« Last Edit: September 21, 2020, 10:26:06 PM by American GenX »

jpdx

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Re: What comes after the ACA?
« Reply #6166 on: September 22, 2020, 12:55:12 AM »
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

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Re: What comes after the ACA?
« Reply #6167 on: September 22, 2020, 06:57:21 AM »
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

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Re: What comes after the ACA?
« Reply #6168 on: September 22, 2020, 07:01:56 AM »
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

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Re: What comes after the ACA?
« Reply #6169 on: September 22, 2020, 07:05:23 AM »
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

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Re: What comes after the ACA?
« Reply #6170 on: September 22, 2020, 07:15:50 AM »
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

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Re: What comes after the ACA?
« Reply #6171 on: September 22, 2020, 07:49:25 AM »
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

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Re: What comes after the ACA?
« Reply #6172 on: September 22, 2020, 08:18:20 AM »
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

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Re: What comes after the ACA?
« Reply #6173 on: September 22, 2020, 09:02:05 AM »
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

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Re: What comes after the ACA?
« Reply #6174 on: September 22, 2020, 09:06:18 AM »
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

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Re: What comes after the ACA?
« Reply #6175 on: September 22, 2020, 09:22:38 AM »
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

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Re: What comes after the ACA?
« Reply #6176 on: September 22, 2020, 10:06:57 AM »
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

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Re: What comes after the ACA?
« Reply #6177 on: September 22, 2020, 10:08:08 AM »
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

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Re: What comes after the ACA?
« Reply #6178 on: September 22, 2020, 10:22:27 AM »
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

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Re: What comes after the ACA?
« Reply #6179 on: September 22, 2020, 03:23:37 PM »
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.
« Last Edit: September 22, 2020, 03:34:43 PM by friedmmj »

Luck12

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Re: What comes after the ACA?
« Reply #6180 on: September 22, 2020, 03:47:43 PM »
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

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Re: What comes after the ACA?
« Reply #6181 on: September 22, 2020, 04:27:46 PM »
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

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Re: What comes after the ACA?
« Reply #6182 on: September 22, 2020, 07:40:43 PM »
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

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Re: What comes after the ACA?
« Reply #6183 on: September 22, 2020, 07:43:06 PM »
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. :)
« Last Edit: September 22, 2020, 08:16:45 PM by bacchi »

pecunia

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Re: What comes after the ACA?
« Reply #6184 on: September 22, 2020, 09:23:10 PM »
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

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Re: What comes after the ACA?
« Reply #6185 on: September 22, 2020, 09:33:43 PM »
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

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Re: What comes after the ACA?
« Reply #6186 on: September 23, 2020, 02:28:43 AM »
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

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Re: What comes after the ACA?
« Reply #6187 on: September 23, 2020, 06:59:59 AM »
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

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Re: What comes after the ACA?
« Reply #6188 on: September 23, 2020, 07:03:02 AM »
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

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Re: What comes after the ACA?
« Reply #6189 on: September 23, 2020, 07:48:04 AM »
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

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Re: What comes after the ACA?
« Reply #6190 on: September 23, 2020, 08:02:30 AM »
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

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Re: What comes after the ACA?
« Reply #6191 on: September 23, 2020, 11:29:23 AM »
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

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Re: What comes after the ACA?
« Reply #6192 on: September 23, 2020, 11:46:55 AM »
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

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Re: What comes after the ACA?
« Reply #6193 on: September 23, 2020, 02:01:00 PM »
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

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Re: What comes after the ACA?
« Reply #6194 on: September 23, 2020, 02:19:13 PM »
They are probably referring to the reinsurance program that PA is about to launch.

rab-bit

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Re: What comes after the ACA?
« Reply #6195 on: September 23, 2020, 02:33:56 PM »
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

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Re: What comes after the ACA?
« Reply #6196 on: September 23, 2020, 02:37:18 PM »
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

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Re: What comes after the ACA?
« Reply #6197 on: September 23, 2020, 02:46:16 PM »
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.
« Last Edit: September 23, 2020, 02:52:24 PM by rab-bit »

Omy

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Re: What comes after the ACA?
« Reply #6198 on: September 25, 2020, 12:26:54 PM »
We can all rest easy...Trump is going to fix the healthcare system with a couple of executive orders.

Exflyboy

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Re: What comes after the ACA?
« Reply #6199 on: September 25, 2020, 12:38:28 PM »
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!