Author Topic: What comes after the ACA?  (Read 1427316 times)

Paul der Krake

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Re: What comes after the ACA?
« Reply #6250 on: September 28, 2020, 05:55:26 PM »
Medicare for all is only widely popular as an abstract idea. Wars and hunger are also very unpopular, but we still have them. As soon as you get into the details of what that means, it just becomes one of those things that everybody wants but only if it’s done my way. FiveThirtyEight has done a lot of reporting on that subject. Here is one such article:

https://fivethirtyeight.com/features/americans-want-the-health-care-system-to-change-just-not-their-own-health-care/

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6251 on: September 28, 2020, 06:22:41 PM »

I'm really not sure what folks think that the counter-balance is to the ACA being overturned in November. 



As to his  application  of  stare decisis, Kavanaugh is quoted as saying that the underpinnings  of the precedent at issue would have to be "egregiously" or "grievously" wrong.

In 1932 Justice Brandeis said it is “more important that the applicable rule of law be settled than that it be settled right."

Brandeis' reasoning  also applies to precedents.


« Last Edit: September 28, 2020, 06:25:39 PM by John Galt incarnate! »

American GenX

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Re: What comes after the ACA?
« Reply #6252 on: September 28, 2020, 09:50:32 PM »
Remember if Biden wins and we get at least a 50/50 Senate any damage they do can be undone.

That's what I was referring to in my response to you, "but there is a chance legislative action by democrats after the election could save it if the stars line up correctly."

Hopefully, the ACA can be saved.  These Universal Healthcare fantasies are not going to happen with the current support in Congress.  There's way too far too go.   Maybe Biden's public option could gain traction.
« Last Edit: September 28, 2020, 09:54:56 PM by American GenX »

American GenX

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Re: What comes after the ACA?
« Reply #6253 on: September 28, 2020, 09:54:23 PM »
The candidate advocating such a plan could only get 30% of the Democrats, the plan is DOA.  Reality is reality.

Well, Bernie Sanders campaigned on giving Medicare to everybody and who wants that? Medicare sucks. It's so expensive and doesn't cover much.

That's true of Medicare part A, which is free for many people over 65, but if you get Medicare B and a supplemental, the coverage is much better, but then that's when it gets more expensive..  To keeps out of pocket costs to a minimum, I know of some couples that have reported spending about $1000/mo for their coverage.

But Bernie's Medicare for All worked differently - massive taxes, and he said there would be no deductibles.

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Re: What comes after the ACA?
« Reply #6254 on: September 29, 2020, 08:14:55 AM »
Medicare for all is only widely popular as an abstract idea. Wars and hunger are also very unpopular, but we still have them. As soon as you get into the details of what that means, it just becomes one of those things that everybody wants but only if it’s done my way. FiveThirtyEight has done a lot of reporting on that subject. Here is one such article:

https://fivethirtyeight.com/features/americans-want-the-health-care-system-to-change-just-not-their-own-health-care/

I think you hit the nail on the head with "great as an abstract idea". As a person with Medicare being a mere 6 years away I started to look at what the actual costs were likely to be.

Um yeah.. Medicare is hideously expensive. My entire SS check will pretty much go to funding Medicare for DW and me.*

I guess this is why we have seniors in poverty


*The Government will be stealing about 1/3rd of my SS check cus I paid into a company pension in the UK.. Oh sorry thats a windfall so the benefits you PAID for, you can't have all of that. Then why did I bother paying into SS then?.

pecunia

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Re: What comes after the ACA?
« Reply #6255 on: September 29, 2020, 08:16:36 AM »
The candidate advocating such a plan could only get 30% of the Democrats, the plan is DOA.  Reality is reality.

Well, Bernie Sanders campaigned on giving Medicare to everybody and who wants that? Medicare sucks. It's so expensive and doesn't cover much.

That's true of Medicare part A, which is free for many people over 65, but if you get Medicare B and a supplemental, the coverage is much better, but then that's when it gets more expensive..  To keeps out of pocket costs to a minimum, I know of some couples that have reported spending about $1000/mo for their coverage.

But Bernie's Medicare for All worked differently - massive taxes, and he said there would be no deductibles.

Yet - Bernie's thing overall was supposed to be cheaper medicine as the premiums would be gone.  It seemed like a good trade.

LaineyAZ

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Re: What comes after the ACA?
« Reply #6256 on: September 29, 2020, 08:22:43 AM »
One of the biggest expenses of Medicare is the cost of prescription drugs.  Biden's platform has said he wants Medicare to negotiate drug prices with pharma companies just like the Veterans Administration does.  So far Republicans have blocked even any discussion of that option.  But if Democrats get elected and that passes, premiums would go down.

ctuser1

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Re: What comes after the ACA?
« Reply #6257 on: September 29, 2020, 08:44:04 AM »
One of the biggest expenses of Medicare is the cost of prescription drugs.  Biden's platform has said he wants Medicare to negotiate drug prices with pharma companies just like the Veterans Administration does.  So far Republicans have blocked even any discussion of that option.  But if Democrats get elected and that passes, premiums would go down.

About 20% of total medicare spending is prescription drugs. So, controlling this will likely save between 5-15% of the costs, depending on hos this is implemented. However, this will have a much higher positive impact on public health that won't be captured in the $$ numbers. I have known people who skips medications due to cost. This will go down.

Prescription drugs will also have an interesting international relations angle. The most common proposal I have heard is to limit the drug pricing to the average/max/some-function of what other OECD countries pay. As soon as that happens, drug prices will rise for everyone else, and go down for the US. Do expect a major back and forth on this where US "partners" try to convince US to not do this. When Drumpf got elected, I was half hoping he would pick this up as a bull in china shop approach could actually be effective in this case and for the amount of benefits it will give to the Americans - totally worth it!!





talltexan

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Re: What comes after the ACA?
« Reply #6258 on: September 29, 2020, 11:29:29 AM »

ACA is done. Cooked. Gone. Now if Biden gets elected and gets a Senate majority, there's a small chance they'll abolish the filibuster and redo it or something similar, but I don't put much hope in it. He'll try to be bipartisan and the Republicans will run the clock on that for 2 years hoping to retake one of the chambers. For all the BS republican propaganda that he's somehow a socialist, he's really just an institutionalist. So don't count on him expanding the court to 13 justices or adding states or pushing Schumer to abolish the filibuster. And that's assuming he wins and the Dems retake the Senate. If both those things don't happen, look for the ACA to be gone/gutted with no replacement and those with pre-existing conditions to be SOL. Gotten Covid? That's a pre-existing condition. Sorry. Overweight, gotten a skin cancer removed, had a cyst removed during your colonoscopy when you turned 50? Congrats, you're now uninsurable until you turn 65.

How anyone in the American fire community can support Republicans is baffling to me.


Do you think  the  ACA's underpinnings are "plainly and palpably, beyond all question, in violation of the fundamental law of the Constitution"?

Among other criteria, the Court would have to  find they are to support a rationale that warrants  overturning the ACA.

Keep in mind that when the Court hears a challenge to legislation's constitutionality the Court presumes  it is constitutional unless it is facially, glaringly unconstitutional.

This presumption comports  with the "cardinal principle of statutory construction [which] is to save and not to destroy."





Lochner v. New York
(1905)


But it is equally true -- indeed, the public interests imperatively demand -- that legislative enactments should be recognized and enforced by the courts as embodying the will of the people unless they are plainly and palpably, beyond all question, in violation of the fundamental law of the Constitution. Justice Harlan (Dissent)



National Labor Relations Board v. Jones & Laughlin Steel Corporation (1937)


 The cardinal principle of statutory construction is to save, and not to destroy. We have repeatedly held that, as between two possible interpretations of a statute, by one of which it would be unconstitutional and by the other valid, our plain duty is to adopt that which will save the act. Even to avoid a serious doubt, the rule is the same. Chief Justice Charles Evans Hughes

ETA: For those of you from outside of the legal world, the case referenced here is basically almost as untouchable as Dred Scott or Plessy. https://en.wikipedia.org/wiki/Anticanon. I read things too quickly while preparing my original post and didn't see that OP had quoted the dissent. Please forgive me for letting my emotions get the better of me. Hopefully people appreciate that I at least try.

« Last Edit: September 30, 2020, 06:35:22 AM by talltexan »

katsiki

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Re: What comes after the ACA?
« Reply #6259 on: September 29, 2020, 03:54:38 PM »

I'm really not sure what folks think that the counter-balance is to the ACA being overturned in November. 



As to his  application  of  stare decisis, Kavanaugh is quoted as saying that the underpinnings  of the precedent at issue would have to be "egregiously" or "grievously" wrong.

In 1932 Justice Brandeis said it is “more important that the applicable rule of law be settled than that it be settled right."

Brandeis' reasoning  also applies to precedents.

What does the bolded part mean in layman's terms?  I understand the words but I think my interpretation of it is likely different than what a lawyer or judge means by it.

EDIT: Just realized you had bolded your last line... So I am asking about the "In 1932..." line.  Thanks for explaining.

AdrianC

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Re: What comes after the ACA?
« Reply #6260 on: September 30, 2020, 07:37:20 AM »
As a person with Medicare being a mere 6 years away I started to look at what the actual costs were likely to be.

Um yeah.. Medicare is hideously expensive. My entire SS check will pretty much go to funding Medicare for DW and me.*

I guess this is why we have seniors in poverty


*The Government will be stealing about 1/3rd of my SS check cus I paid into a company pension in the UK.. Oh sorry thats a windfall so the benefits you PAID for, you can't have all of that. Then why did I bother paying into SS then?.

Just saw this - one of the early FIRE peeps looks at Medicare:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Doesn't sound bad at all. Way better than what we have with a Bronze ACA plan.


Exflyboy

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Re: What comes after the ACA?
« Reply #6261 on: September 30, 2020, 09:02:52 AM »
As a person with Medicare being a mere 6 years away I started to look at what the actual costs were likely to be.

Um yeah.. Medicare is hideously expensive. My entire SS check will pretty much go to funding Medicare for DW and me.*

I guess this is why we have seniors in poverty


*The Government will be stealing about 1/3rd of my SS check cus I paid into a company pension in the UK.. Oh sorry thats a windfall so the benefits you PAID for, you can't have all of that. Then why did I bother paying into SS then?.

Just saw this - one of the early FIRE peeps looks at Medicare:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Doesn't sound bad at all. Way better than what we have with a Bronze ACA plan.

I have not read all of this article but my first question about the 20% thats not covered under part B. Yes a $1M hospital bill is capped at $1408, but how is a $1M on going Chemo bill paid for?

Clearly I need to do more research.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6262 on: September 30, 2020, 09:50:24 AM »
As a person with Medicare being a mere 6 years away I started to look at what the actual costs were likely to be.

Um yeah.. Medicare is hideously expensive. My entire SS check will pretty much go to funding Medicare for DW and me.*

I guess this is why we have seniors in poverty


*The Government will be stealing about 1/3rd of my SS check cus I paid into a company pension in the UK.. Oh sorry thats a windfall so the benefits you PAID for, you can't have all of that. Then why did I bother paying into SS then?.

Just saw this - one of the early FIRE peeps looks at Medicare:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Doesn't sound bad at all. Way better than what we have with a Bronze ACA plan.

I have not read all of this article but my first question about the 20% thats not covered under part B. Yes a $1M hospital bill is capped at $1408, but how is a $1M on going Chemo bill paid for?

Clearly I need to do more research.

The author seems to have a big misunderstanding about what is covered by Part A vs. Part B.  Part A only covers hospital room and board, it does not cover any of the doctors who treat you, surgeries, imaging, etc. that you receive while you are in the hospital (and of course nothing outpatient like the chemo you mentioned).  So the part B 20% co-pay could indeed bankrupt you if you don't have a supplement.

WhiteTrashCash

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Re: What comes after the ACA?
« Reply #6263 on: September 30, 2020, 02:06:37 PM »
As a person with Medicare being a mere 6 years away I started to look at what the actual costs were likely to be.

Um yeah.. Medicare is hideously expensive. My entire SS check will pretty much go to funding Medicare for DW and me.*

I guess this is why we have seniors in poverty


*The Government will be stealing about 1/3rd of my SS check cus I paid into a company pension in the UK.. Oh sorry thats a windfall so the benefits you PAID for, you can't have all of that. Then why did I bother paying into SS then?.

Just saw this - one of the early FIRE peeps looks at Medicare:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Doesn't sound bad at all. Way better than what we have with a Bronze ACA plan.

I have not read all of this article but my first question about the 20% thats not covered under part B. Yes a $1M hospital bill is capped at $1408, but how is a $1M on going Chemo bill paid for?

Clearly I need to do more research.

The author seems to have a big misunderstanding about what is covered by Part A vs. Part B.  Part A only covers hospital room and board, it does not cover any of the doctors who treat you, surgeries, imaging, etc. that you receive while you are in the hospital (and of course nothing outpatient like the chemo you mentioned).  So the part B 20% co-pay could indeed bankrupt you if you don't have a supplement.

Yeah, everything I have read about Medicare (and heard from talking to elderly relatives) shows me that it is a pretty shoddy system. Bernie Sanders wants a Universal Healthcare system for the USA, but his branding is very poor by calling it "Medicare for All". I currently have what is considered a "Cadillac plan" (referring back to the old days when Cadillacs were desirable luxury cars) and Medicare is going to be a steep step down for me when the time comes. I would prefer a plan like what they have in Canada where everything is just taken care of. I'm okay paying a lot more in taxes if it means I have no worries with this stuff. A lot of Americans feel that way.

Mr. Green

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Re: What comes after the ACA?
« Reply #6264 on: September 30, 2020, 02:18:57 PM »
As a person with Medicare being a mere 6 years away I started to look at what the actual costs were likely to be.

Um yeah.. Medicare is hideously expensive. My entire SS check will pretty much go to funding Medicare for DW and me.*

I guess this is why we have seniors in poverty


*The Government will be stealing about 1/3rd of my SS check cus I paid into a company pension in the UK.. Oh sorry thats a windfall so the benefits you PAID for, you can't have all of that. Then why did I bother paying into SS then?.

Just saw this - one of the early FIRE peeps looks at Medicare:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Doesn't sound bad at all. Way better than what we have with a Bronze ACA plan.

I have not read all of this article but my first question about the 20% thats not covered under part B. Yes a $1M hospital bill is capped at $1408, but how is a $1M on going Chemo bill paid for?

Clearly I need to do more research.

The author seems to have a big misunderstanding about what is covered by Part A vs. Part B.  Part A only covers hospital room and board, it does not cover any of the doctors who treat you, surgeries, imaging, etc. that you receive while you are in the hospital (and of course nothing outpatient like the chemo you mentioned).  So the part B 20% co-pay could indeed bankrupt you if you don't have a supplement.

Yeah, everything I have read about Medicare (and heard from talking to elderly relatives) shows me that it is a pretty shoddy system. Bernie Sanders wants a Universal Healthcare system for the USA, but his branding is very poor by calling it "Medicare for All". I currently have what is considered a "Cadillac plan" (referring back to the old days when Cadillacs were desirable luxury cars) and Medicare is going to be a steep step down for me when the time comes. I would prefer a plan like what they have in Canada where everything is just taken care of. I'm okay paying a lot more in taxes if it means I have no worries with this stuff. A lot of Americans feel that way.
I had always thought Medicare was a pretty good deal. Considering the fact that it's insuring the most expensive demographic (by age), the premiums are quite reasonable and the deductibles are better than most plans people have access to, even through employers. At least in all the jobs my wife and I have ever worked it hasn't really been any better. It's an 80/20 split after deductibles, which seems as good as you'll get anywhere, and you can even buy a policy that covers the 20% you're responsible for if you know you need lots of care. Seems like the drug plan may not be all that great, but prescription drug prices in the US in general suck. Are there pitfalls I don't know about?

jim555

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Re: What comes after the ACA?
« Reply #6265 on: September 30, 2020, 02:23:09 PM »
That 20% Medicare responsibility is why people get a Medigap policy.  I calculated it would cost me about $425 a month between Part B, Part D, and Medigap.

CMS puts out a book called "Medicare & You 2021" which explains Medicare.

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6266 on: September 30, 2020, 02:43:10 PM »


In 1932 Justice Brandeis said it is “more important that the applicable rule of law be settled than that it be settled right."

Brandeis' reasoning  also applies to precedents.

What does the bolded part mean in layman's terms?  I understand the words but I think my interpretation of it is likely different than what a lawyer or judge means by it.

EDIT: Just realized you had bolded your last line... So I am asking about the "In 1932..." line.  Thanks for explaining.
[/quote]

I included 1932 because it was a mere  5 years before 1937, the year  West Coast Hotel Co. was decided, the case in which the court adopted Justice Harlan's 1905 dissent in Lochner.

The end of the Lochner Era in 1937 marked  the beginning of significantly greater judicial deference to acts of Congress, particularly those that  regulated and affected the economy.

The rejection of Lochner is of great relevance to this thread because many of today's judges and justices view it as a turning point in the Court's judicial philosophy, a change  in  opposition to  the activist, reactionary  interventions of the pre-1937 Court.

Of singular relevance to the latest challenge to the ACA, which will be heard just weeks from now, is the fact that C.J. Justice Roberts views  Lochner as one of the Court's worst opinions.

  In the initial  challenge to the ACA Roberts' judicial restraint reflected his distaste  for Lochner and will do so again when he decides whether or not stare decisis  should apply to the ACA's latest  challenge.



 
« Last Edit: September 30, 2020, 02:49:57 PM by John Galt incarnate! »

billy

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Re: What comes after the ACA?
« Reply #6267 on: September 30, 2020, 02:58:16 PM »
So for traditional medicare, part A and B both have a seperate annual deductibles? There's no out of pocket max for my share of 20% coinsurance for part A and B? So if the bill is $1,000,000 for A and B combined for the year, my cost is $200,000? Plus the co-pays and monthly premiums?


Exflyboy

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Re: What comes after the ACA?
« Reply #6268 on: September 30, 2020, 03:32:37 PM »
That 20% Medicare responsibility is why people get a Medigap policy.  I calculated it would cost me about $425 a month between Part B, Part D, and Medigap.

CMS puts out a book called "Medicare & You 2021" which explains Medicare.


So about $950/month for a couple?

So my $1200 I'll get from SS.. minus taxes will just about cover our medical.

wenchsenior

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Re: What comes after the ACA?
« Reply #6269 on: September 30, 2020, 03:45:43 PM »
That 20% Medicare responsibility is why people get a Medigap policy.  I calculated it would cost me about $425 a month between Part B, Part D, and Medigap.

CMS puts out a book called "Medicare & You 2021" which explains Medicare.


So about $950/month for a couple?

So my $1200 I'll get from SS.. minus taxes will just about cover our medical.

My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.

Mr. Green

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Re: What comes after the ACA?
« Reply #6270 on: September 30, 2020, 04:07:11 PM »
So for traditional medicare, part A and B both have a seperate annual deductibles? There's no out of pocket max for my share of 20% coinsurance for part A and B? So if the bill is $1,000,000 for A and B combined for the year, my cost is $200,000? Plus the co-pays and monthly premiums?
There's got to be an out of pocket max, yeah? Most seniors without a Medigap policy would instantly be broke with a cancer diagnosis. Maybe that's actually the case but it seems like a terrible gap in the concept.

Edit: There is indeed no out of pocket max. Imagine that. A glaring hole indeed.
« Last Edit: September 30, 2020, 04:09:21 PM by Mr. Green »

Paul der Krake

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Re: What comes after the ACA?
« Reply #6271 on: September 30, 2020, 04:13:17 PM »
The OOP max is that people don’t pay and the hospital settles for whatever they think they can get.

Medicare Advantage plans do have a OOP max. People don’t necessarily trust those plans because there is a perception that they are more likely to deny treatments than traditional Medicare.


jim555

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Re: What comes after the ACA?
« Reply #6272 on: September 30, 2020, 05:01:47 PM »
My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.
Medigap is $200, Part B is $144.60 (may be higher if you have higher income), Part D $35 = $379.60

Mr. Green

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Re: What comes after the ACA?
« Reply #6273 on: September 30, 2020, 05:35:45 PM »
My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.
Medigap is $200, Part B is $144.60 (may be higher if you have higher income), Part D $35 = $379.60
So that person's entire healthcare bill for the year is ~$4,500 plus prescriptions, no matter how much care they need? That sounds like a deal, considering the demographic.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6274 on: September 30, 2020, 06:27:13 PM »
So for traditional medicare, part A and B both have a seperate annual deductibles? There's no out of pocket max for my share of 20% coinsurance for part A and B? So if the bill is $1,000,000 for A and B combined for the year, my cost is $200,000? Plus the co-pays and monthly premiums?
There's got to be an out of pocket max, yeah? Most seniors without a Medigap policy would instantly be broke with a cancer diagnosis. Maybe that's actually the case but it seems like a terrible gap in the concept.

Edit: There is indeed no out of pocket max. Imagine that. A glaring hole indeed.

That's why everyone (well, at least everyone who doesn't want to go bankrupt) must have a medigap policy.  If you have any assets at all, it is not just a "nice to have" thing; it is a must.

jim555

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Re: What comes after the ACA?
« Reply #6275 on: September 30, 2020, 06:36:05 PM »
Those with income under 135% FPL can qualify for Medicare Savings Programs that can cover Part B and other costs, Social Security Extra Help can cover drug costs.  NY has no resource test, other states may have a resource test.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6276 on: September 30, 2020, 06:42:53 PM »
Those with income under 135% FPL can qualify for Medicare Savings Programs that can cover Part B and other costs, Social Security Extra Help can cover drug costs.  NY has no resource test, other states may have a resource test.

I my state (WV), anyone with more than a trivial amount of assets is not eligible.

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Re: What comes after the ACA?
« Reply #6277 on: October 01, 2020, 06:33:14 AM »
Just saw this - one of the early FIRE peeps looks at Medicare:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Doesn't sound bad at all. Way better than what we have with a Bronze ACA plan.

I have not read all of this article but my first question about the 20% thats not covered under part B. Yes a $1M hospital bill is capped at $1408, but how is a $1M on going Chemo bill paid for?

Clearly I need to do more research.
The author seems to have a big misunderstanding about what is covered by Part A vs. Part B.  Part A only covers hospital room and board, it does not cover any of the doctors who treat you, surgeries, imaging, etc. that you receive while you are in the hospital (and of course nothing outpatient like the chemo you mentioned).  So the part B 20% co-pay could indeed bankrupt you if you don't have a supplement.

Isn't that part B co-pay covered by the Medigap policy after deductible? This is his conclusion:

I'm going with traditional fee-for-service Medicare, a high-deductible Plan G Medigap plan with a premium of about $600/yr and the cheapest Part D drug plan offered, that's a premium of about $160/yr at current pricing. And of course, I'll be paying the Medicare Part B premium of about $150/month ($1,800/yr) for a total health premium of about $2,560/yr.

AdrianC

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Re: What comes after the ACA?
« Reply #6278 on: October 01, 2020, 02:11:26 PM »
I had a look at my congressman’s website, Rep. Warren Davidson (R-OH). Under Issues - Health Care, it says:

Republicans have proposed three replacements [for the ACA] so far. You can read more about them at these links:

Link 1… is dead
Link 2… is dead
Link 3 goes to a plan by the former HHS Secretary Tom Price, from 2015. This is not the plan they tried to pass in 2017.

After 10 years the Republicans still have no plan, and clearly don't care that they have no plan. This guy is up for reelection in a month and has dead links on his website. That's how much thought he's putting into healthcare.

https://davidson.house.gov/issues/health-care

toocold

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Re: What comes after the ACA?
« Reply #6279 on: October 01, 2020, 03:45:41 PM »
After 10 years the Republicans still have no plan, and clearly don't care that they have no plan.

The issue is that Republicans had a healthcare plan 25 years ago, during the original Clinton pursuit of healthcare reform.  They wanted market exchanges so that various insurers could compete with each other to drive down prices.  The Democrats originally wanted to expand Medicare and Medicaid to cover all Americans.

When the ACA was formed, it essentially took the Republican "RomneyCare" plan and added subsidies, got rid of preexisting conditions, unified the product offerings, standardized the insurance information,  and raised Medicaid eligibility.  All of these add-ons were popular. 

But because it was the "Democrat's" plan, none of the Republican signed on.  The Democrats shoe horned it in anyway, with the Republican vowing to pursue the "nuclear plan" to eventually strike it down.

So essentially, Republicans are trying to strike down their own plan.  That's why they don't have a plan, only cursory modifications.

Our government is so...



« Last Edit: October 01, 2020, 03:51:29 PM by toocold »

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6280 on: October 01, 2020, 05:33:51 PM »
I had a look at my congressman’s website, Rep. Warren Davidson (R-OH). Under Issues - Health Care, it says:

Republicans have proposed three replacements [for the ACA] so far. You can read more about them at these links:

Link 1… is dead
Link 2… is dead
Link 3 goes to a plan by the former HHS Secretary Tom Price, from 2015. This is not the plan they tried to pass in 2017.

After 10 years the Republicans still have no plan, and clearly don't care that they have no plan. This guy is up for reelection in a month and has dead links on his website. That's how much thought he's putting into healthcare.
https://davidson.house.gov/issues/health-care

Which shows what little regard he has for his constituents.
« Last Edit: October 01, 2020, 05:41:44 PM by John Galt incarnate! »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6281 on: October 01, 2020, 05:46:21 PM »
Just saw this - one of the early FIRE peeps looks at Medicare:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Doesn't sound bad at all. Way better than what we have with a Bronze ACA plan.

I have not read all of this article but my first question about the 20% thats not covered under part B. Yes a $1M hospital bill is capped at $1408, but how is a $1M on going Chemo bill paid for?

Clearly I need to do more research.
The author seems to have a big misunderstanding about what is covered by Part A vs. Part B.  Part A only covers hospital room and board, it does not cover any of the doctors who treat you, surgeries, imaging, etc. that you receive while you are in the hospital (and of course nothing outpatient like the chemo you mentioned).  So the part B 20% co-pay could indeed bankrupt you if you don't have a supplement.

Isn't that part B co-pay covered by the Medigap policy after deductible? This is his conclusion:

I'm going with traditional fee-for-service Medicare, a high-deductible Plan G Medigap plan with a premium of about $600/yr and the cheapest Part D drug plan offered, that's a premium of about $160/yr at current pricing. And of course, I'll be paying the Medicare Part B premium of about $150/month ($1,800/yr) for a total health premium of about $2,560/yr.

Reading a little more closely, it seems that he does understand what is covered by part A vs. part B.  But runs the risk of misleading people when he says "Sure it's a 20% co-pay on doctor's bills, but the copay on a $1 million hospital bill is capped at just $1,408 for a 60-day stay-- that's not even 1%."  He makes it sound like Part A is covering everything that happens when you're in the hospital. 

sherr

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Re: What comes after the ACA?
« Reply #6282 on: October 01, 2020, 08:52:22 PM »
After 10 years the Republicans still have no plan, and clearly don't care that they have no plan.

The issue is that Republicans had a healthcare plan 25 years ago, during the original Clinton pursuit of healthcare reform.  They wanted market exchanges so that various insurers could compete with each other to drive down prices.  The Democrats originally wanted to expand Medicare and Medicaid to cover all Americans.

When the ACA was formed, it essentially took the Republican "RomneyCare" plan and added subsidies, got rid of preexisting conditions, unified the product offerings, standardized the insurance information,  and raised Medicaid eligibility.  All of these add-ons were popular. 

But because it was the "Democrat's" plan, none of the Republican signed on.  The Democrats shoe horned it in anyway, with the Republican vowing to pursue the "nuclear plan" to eventually strike it down.

So essentially, Republicans are trying to strike down their own plan.  That's why they don't have a plan, only cursory modifications.

Our government is so...

So you're saying the Democrats took the Republican plan and made a few popular and sensible updates.

And then the Republicans oppose it just because it's the Democrats doing it, but Dems "shoehorn it in anyway" (aka serve the public and do their job).

And then the Republicans try to kill it even though they can't come up with a better replacement.

And then you "both sides" it with "our government is so..."?! Let's give credit where credit is due. Republicans are so...
« Last Edit: October 01, 2020, 08:59:43 PM by sherr »

bacchi

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Re: What comes after the ACA?
« Reply #6283 on: October 01, 2020, 09:38:30 PM »
After 10 years the Republicans still have no plan, and clearly don't care that they have no plan.

The issue is that Republicans had a healthcare plan 25 years ago, during the original Clinton pursuit of healthcare reform.  They wanted market exchanges so that various insurers could compete with each other to drive down prices.  The Democrats originally wanted to expand Medicare and Medicaid to cover all Americans.

When the ACA was formed, it essentially took the Republican "RomneyCare" plan and added subsidies, got rid of preexisting conditions, unified the product offerings, standardized the insurance information,  and raised Medicaid eligibility.  All of these add-ons were popular. 

But because it was the "Democrat's" plan, none of the Republican signed on.  The Democrats shoe horned it in anyway, with the Republican vowing to pursue the "nuclear plan" to eventually strike it down.

So essentially, Republicans are trying to strike down their own plan.  That's why they don't have a plan, only cursory modifications.

Our government is so...

So you're saying the Democrats took the Republican plan and made a few popular and sensible updates.

And then the Republicans oppose it just because it's the Democrats doing it, but Dems "shoehorn it in anyway" (aka serve the public and do their job).

And then the Republicans try to kill it even though they can't come up with a better replacement.

And then you "both sides" it with "our government is so..."?! Let's give credit where credit is due. Republicans are so...

Even earlier, the individual mandate was proposed by...the Heritage Foundation, with support from the AEI and Milton Friedman. George W. Bush was considering a plan for an individual mandate, pre-Enthoven (the architect of the Dutch system).

Grassley and other well known conservative politicians supported a bill in 1993 that had a mandate and subsidies.

toocold

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Re: What comes after the ACA?
« Reply #6284 on: October 02, 2020, 07:15:48 AM »
And then you "both sides" it with "our government is so..."?! Let's give credit where credit is due. Republicans are so...

No I mean both sides -- and I'm trying to be a politically neutral here. But are you suggesting that only one side is ever hypocritical?

former player

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Re: What comes after the ACA?
« Reply #6285 on: October 02, 2020, 07:33:02 AM »
And then you "both sides" it with "our government is so..."?! Let's give credit where credit is due. Republicans are so...

No I mean both sides -- and I'm trying to be a politically neutral here. But are you suggesting that only one side is ever hypocritical?
In the particular instance quoted in the post, relating to health care, yes

toocold

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Re: What comes after the ACA?
« Reply #6286 on: October 02, 2020, 07:35:26 AM »
And then you "both sides" it with "our government is so..."?! Let's give credit where credit is due. Republicans are so...

No I mean both sides -- and I'm trying to be a politically neutral here. But are you suggesting that only one side is ever hypocritical?
In the particular instance quoted in the post, relating to health care, yes

I agree with you.  That's why they are stuck without a plan (which was the original post I wrote). 

When there was the vote to strike ACA down in the Senate, there were only a couple of moderate gop, including McCain, that chose to look out for people rather than fall within party line.

Too many in Congress are more concerned with "winning" and looking "good" for elections than they are with passing sensible, practical laws, which creates too many cases of hypocrisy -- both sides.
« Last Edit: October 02, 2020, 07:48:49 AM by toocold »

sherr

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Re: What comes after the ACA?
« Reply #6287 on: October 02, 2020, 07:49:41 AM »
And then you "both sides" it with "our government is so..."?! Let's give credit where credit is due. Republicans are so...

No I mean both sides -- and I'm trying to be a politically neutral here. But are you suggesting that only one side is ever hypocritical?

If the Democrats do something bad then feel free to blame them for it. But in this case it seems like 100% of the blame is on Republicans. False neutrality / false equivalence does no one any favors, hold people accountable for their own actions and you may actually see the parties improve.
« Last Edit: October 02, 2020, 08:00:06 AM by sherr »

toocold

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Re: What comes after the ACA?
« Reply #6288 on: October 02, 2020, 08:05:17 AM »
And then you "both sides" it with "our government is so..."?! Let's give credit where credit is due. Republicans are so...

No I mean both sides -- and I'm trying to be a politically neutral here. But are you suggesting that only one side is ever hypocritical?

If the Democrats do something bad then feel free to blame them for it. But in this case it seems like 100% of the blame is on Republicans. False neutrality / false equivalence does no one any favors, hold people accountable for their own actions and you may actually see the parties improve.

Nope. Democrats are intransigent about wanting to pass something BIG rather than what both sides have agreed to, such as more PPE to schools, extensions to unemployment benefits, support for certain industries, expansion of PPP for small business.   They also want to pass things that have nothing to do with the pandemic, such as repeal of SALT. 

If they pass both measures that both sides agree to, it could help alot of people, including stopping 32k being furloughed, but they rather win.

Both sides.. 
« Last Edit: October 02, 2020, 08:10:19 AM by toocold »

Shane

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Re: What comes after the ACA?
« Reply #6289 on: October 02, 2020, 09:02:29 AM »
Those with income under 135% FPL can qualify for Medicare Savings Programs that can cover Part B and other costs, Social Security Extra Help can cover drug costs.  NY has no resource test, other states may have a resource test.

I my state (WV), anyone with more than a trivial amount of assets is not eligible.

PA also has no asset test for Medicaid. Our FIRE income is below 138%FPL, so we qualify for 100% free healthcare. We got a flu shot the other day. Just showed the pharmacist at Riteaid our insurance cards, and there was no charge. I haven't been to the doctor in PA, yet, but my wife has gone in for a check up and some tests, and pretty sure it was all free. She may have had to pay a small copay for a prescription she got. I think it was $2. This is the way healthcare should be for EVERYONE!
« Last Edit: October 02, 2020, 06:10:46 PM by Shane »

geekette

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Re: What comes after the ACA?
« Reply #6290 on: October 02, 2020, 10:17:17 AM »
Anyone on an ACA plan gets free flu shots (as well as others - I just got Prevnar and Shingrix free too).  Annual physicals are covered in full as well.

jim555

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Re: What comes after the ACA?
« Reply #6291 on: October 02, 2020, 10:37:34 AM »
Those with income under 135% FPL can qualify for Medicare Savings Programs that can cover Part B and other costs, Social Security Extra Help can cover drug costs.  NY has no resource test, other states may have a resource test.

I my state (WV), anyone with more than a trivial amount of assets is not eligible.

PA also has no asset test for Medicare. Our FIRE income is below 138%FPL, so we qualify for 100% free healthcare. We got a flu shot the other day. Just showed the pharmacist at Riteaid our insurance cards, and there was no charge. I haven't been to the doctor in PA, yet, but my wife has gone in for a check up and some tests, and pretty sure it was all free. She may have had to pay a small copay for a prescription she got. I think it was $2. This is the way healthcare should be for EVERYONE!
I think you mean Medicaid, the expansion group has a sole 138% income test in all states that expanded.  MediCARE Saving Programs, Social Security Extra Help have an asset test in most states.

JGS1980

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Re: What comes after the ACA?
« Reply #6292 on: October 02, 2020, 01:12:39 PM »
People are STILL confused?

This link is actually a decent primer no the difference between Medicaid, Medicare (A, B, D), etc... in the context of early retirees.

Hope this helps.

JGS

https://www.whitecoatinvestor.com/health-insurance-in-early-retirement/

American GenX

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Re: What comes after the ACA?
« Reply #6293 on: October 02, 2020, 02:46:09 PM »
People are STILL confused?

This link is actually a decent primer no the difference between Medicaid, Medicare (A, B, D), etc... in the context of early retirees.

Hope this helps.

JGS

https://www.whitecoatinvestor.com/health-insurance-in-early-retirement/

I know all about this stuff already, but I took a look at your linked page out of curiosity.  I don't think it clarifies info on Medicaid very well, and there's some incorrect and misleading info on that page.

American GenX

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Re: What comes after the ACA?
« Reply #6294 on: October 02, 2020, 02:48:20 PM »
My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.
Medigap is $200, Part B is $144.60 (may be higher if you have higher income), Part D $35 = $379.60

And some people are paying a lot more than that.  I've known couples paying $1000/mo, and it still doesn't cover everything.

Medicare is so expensive, there a big bump in my retirement budget for when I have to switch from ACA to Medicare.  I heard Biden wants people to be able to get Medicare at age 60.  That will just increase my retirement costs.

Mr. Green

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Re: What comes after the ACA?
« Reply #6295 on: October 02, 2020, 03:03:33 PM »
My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.
Medigap is $200, Part B is $144.60 (may be higher if you have higher income), Part D $35 = $379.60

And some people are paying a lot more than that.  I've known couples paying $1000/mo, and it still doesn't cover everything.

Medicare is so expensive, there a big bump in my retirement budget for when I have to switch from ACA to Medicare.  I heard Biden wants people to be able to get Medicare at age 60.  That will just increase my retirement costs.
While Medicare will be more costly than someone getting significant subsidies through the ACA, adding people younger than 65 years old should help bring down the overall cost if Medicare, as they are statistically healthier. I wouldn'texpect to see large reductions for just 60-64 year olds, though.

jim555

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Re: What comes after the ACA?
« Reply #6296 on: October 02, 2020, 06:05:23 PM »
My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.
Medigap is $200, Part B is $144.60 (may be higher if you have higher income), Part D $35 = $379.60

And some people are paying a lot more than that.  I've known couples paying $1000/mo, and it still doesn't cover everything.

Medicare is so expensive, there a big bump in my retirement budget for when I have to switch from ACA to Medicare.  I heard Biden wants people to be able to get Medicare at age 60.  That will just increase my retirement costs.
From what I read Biden wants a Medicare like public option, and the option for Medicare at age 60, but these aren't replacing the ACA, it is just more choices.  Instead of a Silver benchmark he would benchmark on a Gold plan, increasing the subsidies and lowering out of pocket costs.  Get rid of the 400% FPL cliff and cap the costs at 8.5% max.  He would cover the Medicaid gap in non expansion states with the public option plan so those people get coverage.
« Last Edit: October 02, 2020, 06:11:50 PM by jim555 »

Shane

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Re: What comes after the ACA?
« Reply #6297 on: October 02, 2020, 06:12:20 PM »
Those with income under 135% FPL can qualify for Medicare Savings Programs that can cover Part B and other costs, Social Security Extra Help can cover drug costs.  NY has no resource test, other states may have a resource test.

I my state (WV), anyone with more than a trivial amount of assets is not eligible.

PA also has no asset test for Medicare. Our FIRE income is below 138%FPL, so we qualify for 100% free healthcare. We got a flu shot the other day. Just showed the pharmacist at Riteaid our insurance cards, and there was no charge. I haven't been to the doctor in PA, yet, but my wife has gone in for a check up and some tests, and pretty sure it was all free. She may have had to pay a small copay for a prescription she got. I think it was $2. This is the way healthcare should be for EVERYONE!
I think you mean Medicaid, the expansion group has a sole 138% income test in all states that expanded.  MediCARE Saving Programs, Social Security Extra Help have an asset test in most states.

Yes, I meant to say Medicaid. Edited my comment above. Thank you Jim!

American GenX

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Re: What comes after the ACA?
« Reply #6298 on: October 03, 2020, 11:52:20 AM »
My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.
Medigap is $200, Part B is $144.60 (may be higher if you have higher income), Part D $35 = $379.60

And some people are paying a lot more than that.  I've known couples paying $1000/mo, and it still doesn't cover everything.

Medicare is so expensive, there a big bump in my retirement budget for when I have to switch from ACA to Medicare.  I heard Biden wants people to be able to get Medicare at age 60.  That will just increase my retirement costs.
While Medicare will be more costly than someone getting significant subsidies through the ACA, adding people younger than 65 years old should help bring down the overall cost if Medicare, as they are statistically healthier. I wouldn'texpect to see large reductions for just 60-64 year olds, though.

You're still covering everyone you would have covered before, except now you're covering them an extra 5 years.   I read that the estimated cost over a decade was an extra $200 BILLION and that it would come from the general fund.
« Last Edit: October 04, 2020, 06:42:13 PM by American GenX »

American GenX

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Re: What comes after the ACA?
« Reply #6299 on: October 03, 2020, 12:00:22 PM »
My mom's entire income is 1200$/mo SS, and her Medigap policy is about $200/mo, so there are cheaper ones to be had that are fine.
Medigap is $200, Part B is $144.60 (may be higher if you have higher income), Part D $35 = $379.60

And some people are paying a lot more than that.  I've known couples paying $1000/mo, and it still doesn't cover everything.

Medicare is so expensive, there a big bump in my retirement budget for when I have to switch from ACA to Medicare.  I heard Biden wants people to be able to get Medicare at age 60.  That will just increase my retirement costs.
From what I read Biden wants a Medicare like public option, and the option for Medicare at age 60, but these aren't replacing the ACA, it is just more choices.  Instead of a Silver benchmark he would benchmark on a Gold plan, increasing the subsidies and lowering out of pocket costs.  Get rid of the 400% FPL cliff and cap the costs at 8.5% max.  He would cover the Medicaid gap in non expansion states with the public option plan so those people get coverage.

I hadn't dug into the details, which would change before something like that would ever become law.  If it's optional, that's good, although they may end up being squeezed into it one way or another.  Of course, at this point, it's not looking very promising that the ACA will even be around in another year or so, let alone by the time I'm 60!  So, I'm not going to worry about it.