Author Topic: What comes after the ACA?  (Read 1675281 times)

jim555

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Re: What comes after the ACA?
« Reply #6700 on: March 13, 2021, 07:11:11 PM »
Most states don't use fee for service Medicaid, they use Managed Care plans that are similar to a Medicare Advantage plan.  The doctor network is defined in the plan, so finding a doctor isn't hard since they agree to be in the plan.

Exflyboy

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Re: What comes after the ACA?
« Reply #6701 on: March 13, 2021, 07:34:58 PM »
Personally, I don't consider non-silver plans anymore. 94 and 87 silvers is where the real value is at, as far as I'm concerned. I just filter plans accordingly and don't even see the rest.

My experience has been the opposite (maybe my advanced age perhaps?). When I look at the cost comparisons I find that the extra premium for the silver vs bronze plans more or less pays for the difference in Max out of pocket costs.. Except with the Bronze you might not spend that much on Healthcare. we are pretty healthy so rarely need medical care.. broken wrist+ surgery in 2019 notwithstanding.

Add to that (in our area at least) you have to go Bronze if you want to reduce your income with an HSA which is worth it to avoid our lovely Oregon State income tax.
Are you sure you're looking at silver plans with CSRs? If I recall correctly, you have a fairly "high" income for a pair of retirees, which is likely the reason. If you put anything above 250% FPL you just won't see any of them.

I assumed that the CSR's showed up in the costs of the plan when I put my info in? I.e the plan will be this much per month and your deductible/max OOP will be... Are the CSR's hidden somewhere??

in 2020 we had a MAGI of 162% and in 2019 we had 200% (by maxing out our HSA's)

I found that we could have the Bronze plan for about $10/m with $7k deductible/max OOP.

From memory the silver plan ran about $200/month with a max OOP of around $5k.. So clearly the Bronze plan was a better deal (I am assuming our MAGI would be the same in the above examples)

This year we have already pulled out some spending money so going Silver would prevent us from using an HSA. None of the plans around here had silvers that were "high deductible".


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Re: What comes after the ACA?
« Reply #6702 on: March 13, 2021, 08:26:42 PM »
Personally, I don't consider non-silver plans anymore. 94 and 87 silvers is where the real value is at, as far as I'm concerned. I just filter plans accordingly and don't even see the rest.

My experience has been the opposite (maybe my advanced age perhaps?). When I look at the cost comparisons I find that the extra premium for the silver vs bronze plans more or less pays for the difference in Max out of pocket costs.. Except with the Bronze you might not spend that much on Healthcare. we are pretty healthy so rarely need medical care.. broken wrist+ surgery in 2019 notwithstanding.

Add to that (in our area at least) you have to go Bronze if you want to reduce your income with an HSA which is worth it to avoid our lovely Oregon State income tax.
Are you sure you're looking at silver plans with CSRs? If I recall correctly, you have a fairly "high" income for a pair of retirees, which is likely the reason. If you put anything above 250% FPL you just won't see any of them.

I assumed that the CSR's showed up in the costs of the plan when I put my info in? I.e the plan will be this much per month and your deductible/max OOP will be... Are the CSR's hidden somewhere??

in 2020 we had a MAGI of 162% and in 2019 we had 200% (by maxing out our HSA's)

I found that we could have the Bronze plan for about $10/m with $7k deductible/max OOP.

From memory the silver plan ran about $200/month with a max OOP of around $5k.. So clearly the Bronze plan was a better deal (I am assuming our MAGI would be the same in the above examples)

This year we have already pulled out some spending money so going Silver would prevent us from using an HSA. None of the plans around here had silvers that were "high deductible".

It should be quoted in the plan details when you shop for a plan, as long as the income you put into the tool meets the criteria.

I'm looking at plans with Kaiser Permanente here in Washington.

The HSA bronze plan has a $6,050 individual deductible and $6,900 out-of-pocket max. There's 40% coinsurance on everything after deductible so you hit the out-of-pocket max after $8,175 of medical bills.

Their "flex silver" plan for higher-income people has a $1,800 individual deductible, $7,900 out-of-pocket maximum, and 30% coinsurance. The out-of-pocket maximum is higher than with the HSA plan (kinda weird), but you need to rack up $22k of medical bills to get there.

The 87% CSR version of their "flex silver" plan has a $600 deductible, $2,950 out-of-pocket maximum, and 10% coinsurance. Not only is the out-of-pocket max less than half of what the bronze plan has, but you have to use $24,100 worth of medical services to get there.

Of course the silver plan does come with a higher premium. The older you are, the bigger the difference will be, and in many cases the bronze plan will actually be free because it costs less than the subsidy. Now that the subsidies are higher with the new law, the silver plan will look like a better deal in more cases than it did before. The bronze plan will still be free but the silver plan will be cheaper.

Exflyboy

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Re: What comes after the ACA?
« Reply #6703 on: March 13, 2021, 09:11:21 PM »
Interesting (Kaiser is cheaper but even thought their plans are available to us, their network starts about 40 miles North of us which is too much hassle. Providence is at our local hospital so we're kinda stuck with them.

We have at present about 4 years worth of spend in cash so no need to sell anymore assets next year which will mean our MAGI will be around the 200% FPL even without using the HSA.

Sounds like that might be a good opportunity to go Silver CSR.. Assuming somehow I was missing the extra cost sharing deal when I put our MAGI number in.

Paul der Krake

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Re: What comes after the ACA?
« Reply #6704 on: March 13, 2021, 09:32:10 PM »
If you can accurately project the MAGI down to the dollar, you really want to be under 200% FPL. The difference in cost reduction between 199% (CSR 87) and 201% (CSR 73) is drastic. Literally thousands of dollars off the deductible. Same thing for the cliff between CSR 94 and CSR87.

I put in a 55 year old married couple in Benton County, OR into healthsherpa.com. Look how much difference just a few dollars can make.

MAGI $34,480:


MAGI $34,485:



I used the Kaiser plan because it came first in the results, but any other plan with CSR would show a similar discrepancy.

Know your cliffs.
« Last Edit: March 13, 2021, 09:34:23 PM by Paul der Krake »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6705 on: March 14, 2021, 04:41:14 AM »
In our situation, the sweet spot is to get income just high enough to stay off of Medicaid, and no higher.  We end up with a very low cost silver plan (a couple of years ago it was almost free) that has very good coverage (around 4k total out of pocket limit for two people).  There is no way I would trade that deal for a Roth conversion that may (or may not) save me a few bucks in taxes 20 years from now.  But of course, your IRA situation is highly personal.  In my case, the amount I have in my traditional IRA is unlikely to generate a large tax liability when RMDs roll around.

Just curious, what would be the advantage of staying off of Medicaid? From my perspective, Medicaid seems like the best possible insurance, as it covers 100% of everything, with no OOP, no deductibles, no copays.

In my state, a narrower provider network.  The ACA plan I'm on is a Blue Cross/Blue Shield plan that includes over 95% of providers in the state, and many providers in neighboring states.  Plus nationwide emergency/urgent coverage through the BCBS network.  My wife went through some major health stuff last year that really reinforced the desirability of being able to go to any provider we want.

geekette

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Re: What comes after the ACA?
« Reply #6706 on: March 14, 2021, 07:15:49 AM »
IIRC, there is no claw back provision for CSR, so if you predict your income to be 200% of the FPL, and go over, the only change at tax time will be an adjustment in your premium.

I wouldn’t recommend predicting low and earning high multiple years, but a small windfall one year shouldn’t be a problem for the CSR.

Exflyboy

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Re: What comes after the ACA?
« Reply #6707 on: March 14, 2021, 01:13:16 PM »
If you can accurately project the MAGI down to the dollar, you really want to be under 200% FPL. The difference in cost reduction between 199% (CSR 87) and 201% (CSR 73) is drastic. Literally thousands of dollars off the deductible. Same thing for the cliff between CSR 94 and CSR87.

I put in a 55 year old married couple in Benton County, OR into healthsherpa.com. Look how much difference just a few dollars can make.

MAGI $34,480:


MAGI $34,485:



I used the Kaiser plan because it came first in the results, but any other plan with CSR would show a similar discrepancy.

Know your cliffs.

Interesting website.. I just did the same thing for us and got similar results. Kaiser is a screaming deal compared to the other providers in our area. The problem with Kaiser is their network starts about 45 miles or so North of us.

Now in Oregon they are not allowed to balance bill you if you go into an in-network ER and see a non network provider.. Now I know in theory you are covered for emergency services even out of network but I wonder if there is a ma$$ive bear trap somewhere? (update.. There is.. Balance billing!). I would need to look at this some more. Maybe it just means if you get admitted to hospital for non emergent stuff you simply have to be 45 miles away which is no big deal,

The Kaiser Silver+ CSR plan is $91 for us.. But Providence (network covers our area) is $239/month for basically the same plan.

At $239 we would be spending an extra $2760 per year on premiums compared with our bronze plan ($10/m) going with Providence. Our max OOP is $7300 at silver+CSR which is slightly MORE than on the Bronze plan!!

So it looks like going with Providence bronze is still more cost effective.

But maybe Kaiser silver being a little further away is workable.

Note with Bronze there is no drug coverage so we end up buying from the UK but even those costs are more than what is covered under Kaiser Silver.

Food for thought for sure.
« Last Edit: March 14, 2021, 02:52:00 PM by Exflyboy »

Exflyboy

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Re: What comes after the ACA?
« Reply #6708 on: March 14, 2021, 01:38:18 PM »
Update to above.

If you got to an out of network hospital for emergency care then yes you are are covered under the ACA.. Your insurance provider has to pay the greatest of three measures... The largest if these appears to be the "Usual and customary charges" for the services you receive.

But (from what I read), there is nothing to prevent the service provider from simply charging double the usual rate and when the insurance provider only pays half.. Well then you can be billed directly for the other half.

I would really like the Biden administration to close this loophole. I'm sure the argument is "They would never charge such an outrageous amount"... Sure, then it won't cost anybody anything to write a law to prevent it happening then will it?

As we advance in age the risk of a heart attack/stroke increases and as we spend the majority of our time where we live, it seems prudent to be In-Network for emergency care, especially in Oregon where balance billing is illegal by State law (IN-network hospital for emergency services only).

I can't tell you how comforting it was sat in in an ER in my hometown and knowing that I would not be getting a bill over and above the $8000 it was going to cost me anyway.

Still.. $8000.. like F me!..:(

« Last Edit: March 14, 2021, 02:48:51 PM by Exflyboy »

secondcor521

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Re: What comes after the ACA?
« Reply #6709 on: March 14, 2021, 05:16:55 PM »
Update to above.

If you got to an out of network hospital for emergency care then yes you are are covered under the ACA.. Your insurance provider has to pay the greatest of three measures... The largest if these appears to be the "Usual and customary charges" for the services you receive.

But (from what I read), there is nothing to prevent the service provider from simply charging double the usual rate and when the insurance provider only pays half.. Well then you can be billed directly for the other half.

I would really like the Biden administration to close this loophole. I'm sure the argument is "They would never charge such an outrageous amount"... Sure, then it won't cost anybody anything to write a law to prevent it happening then will it?

As we advance in age the risk of a heart attack/stroke increases and as we spend the majority of our time where we live, it seems prudent to be In-Network for emergency care, especially in Oregon where balance billing is illegal by State law (IN-network hospital for emergency services only).

I can't tell you how comforting it was sat in in an ER in my hometown and knowing that I would not be getting a bill over and above the $8000 it was going to cost me anyway.

Still.. $8000.. like F me!..:(

There may not be a need for the Biden administration to do so, since a federal law was passed under the previous administration to address this issue in December 2020:

https://www.npr.org/sections/health-shots/2020/12/22/949047358/congress-acts-to-spare-consumers-from-costly-surprise-medical-bills

Exflyboy

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Re: What comes after the ACA?
« Reply #6710 on: March 14, 2021, 09:40:26 PM »
@secondcor521

From the two articles I've read on this new law it only prevents balance billing from providers from WITHIN IN-Network Emergency rooms.

I.e, even though the ACA provides for emergency care in out of network facilities nationwide, this law does not appear to prevent balance billing from those out of network hospitals (or providers from within) if you have the misfortune to be dragged into one from a car wreck.

In fact as networks are now so small its highly likely if you are involved in a car wreck you will be in an out of network hospital and have no ability to refuse care and thus wide open to balance billing.

Maybe I am not reading it correctly but if I'm right then the new law doesn't provide much in the way of balance billing protection.. Certainly not enough for me to be in a network that does not cover my local hospital.

I'd love to be proven wrong...

secondcor521

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Re: What comes after the ACA?
« Reply #6711 on: March 14, 2021, 10:23:02 PM »
@secondcor521

From the two articles I've read on this new law it only prevents balance billing from providers from WITHIN IN-Network Emergency rooms.

I.e, even though the ACA provides for emergency care in out of network facilities nationwide, this law does not appear to prevent balance billing from those out of network hospitals (or providers from within) if you have the misfortune to be dragged into one from a car wreck.

In fact as networks are now so small its highly likely if you are involved in a car wreck you will be in an out of network hospital and have no ability to refuse care and thus wide open to balance billing.

Maybe I am not reading it correctly but if I'm right then the new law doesn't provide much in the way of balance billing protection.. Certainly not enough for me to be in a network that does not cover my local hospital.

I'd love to be proven wrong...

Hmm.  Did you read the article I linked?  It seems to specifically address the concern you outlined:

"'No law is perfect," says Zack Cooper, an associate professor of public health and economics at Yale who studies health care pricing. 'But it fundamentally protects patients from being balance-billed. That's a remarkable achievement.' (Balance billing is when out-of-network medical providers bill patients for amounts their insurer did not cover.)"

"Starting in 2022, when the law goes into effect, consumers won't get balance bills when they seek emergency care, when they are transported by an air ambulance, or when they receive nonemergency care at an in-network hospital but are unknowingly treated by an out-of-network physician or laboratory."

Notice that the last quote includes both emergency care (the situation you mention) and out-of-network providers at an in-network hospital (which is the situation that you seem to think is the only one covered).  The way I read it it's both.

If you want to, you can look at the law itself - it's division BB of the Consolidated Appropriations Act of 2021:

https://www.congress.gov/bill/116th-congress/house-bill/133/text

The law starts on page 1578 of the PDF here:

https://www.congress.gov/116/bills/hr133/BILLS-116hr133enr.pdf

Exflyboy

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Re: What comes after the ACA?
« Reply #6712 on: March 14, 2021, 10:37:49 PM »
You're right!.. I just found the actual law, sections 102 and 104 clearly state that insurance plans hold patients harmless from out of network facilities and providers balance billing practices.

Wow that changes one of the major issues of the US healthcare system.. dayum!


secondcor521

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Re: What comes after the ACA?
« Reply #6713 on: March 14, 2021, 11:06:46 PM »
You're right!.. I just found the actual law, sections 102 and 104 clearly state that insurance plans hold patients harmless from out of network facilities and providers balance billing practices.

Wow that changes one of the major issues of the US healthcare system.. dayum!

Now all we need to do is fix daylight savings time ;-)

hdatontodo

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Re: What comes after the ACA?
« Reply #6714 on: March 15, 2021, 02:11:29 AM »
Quote
Now all we need to do is fix daylight savings time ;-)

Daylight Saving Time

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Monkey Uncle

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Re: What comes after the ACA?
« Reply #6715 on: March 15, 2021, 03:05:56 AM »
You're right!.. I just found the actual law, sections 102 and 104 clearly state that insurance plans hold patients harmless from out of network facilities and providers balance billing practices.

Wow that changes one of the major issues of the US healthcare system.. dayum!

So the insurance companies are the ones left holding the bag.  Which means the cost ultimately gets passed on to consumers (or taxpayers) in the form of higher premiums.  Nice to see that lawmakers still don't have the guts to rein in ridiculous charges by providers.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #6716 on: March 15, 2021, 09:57:21 AM »
So the insurance companies are the ones left holding the bag.  Which means the cost ultimately gets passed on to consumers (or taxpayers) in the form of higher premiums.  Nice to see that lawmakers still don't have the guts to rein in ridiculous charges by providers.

I would rather the insurance companies hold the bag though, because they can negotiate ridiculous charges down to something reasonable, where the individual getting balance billed cannot.

You can see a charge for $900 getting reduced to something like $100 by insurance companies when you look at your statements.  Good luck getting that level of reduction as an individual.

DaMa

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Re: What comes after the ACA?
« Reply #6717 on: March 15, 2021, 10:38:47 AM »
So the insurance companies are the ones left holding the bag.  Which means the cost ultimately gets passed on to consumers (or taxpayers) in the form of higher premiums.  Nice to see that lawmakers still don't have the guts to rein in ridiculous charges by providers.

I would rather the insurance companies hold the bag though, because they can negotiate ridiculous charges down to something reasonable, where the individual getting balance billed cannot.

You can see a charge for $900 getting reduced to something like $100 by insurance companies when you look at your statements.  Good luck getting that level of reduction as an individual.

We also get to create another layer of bureaucracy in consultants and arbitrators to do the after-care negotiations, which will just add to the cost of insurance.  Requiring providers to use prices that are based in reality would add no costs and reduce the expenses of insurance companies.

Exflyboy

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Re: What comes after the ACA?
« Reply #6718 on: March 15, 2021, 11:46:16 AM »
Well no law is perfect but at least this goes some way towards not getting thrown to the wolves.

As a lot of these medical practices are now owned by private equity firms and (surprise surprise) this is where a  good proportion of hideous charges come from..

In a way the fact costs are going to rise make me happy because eventually we will realise this system is unsustainable and then perhaps we can fix it properly.

Imagine laying on a gurney after a traffic accident 50 miles away from home and your biggest fear is how many thousands of $$ this is going to cost you... Its just outrageous in the wealthiest country in the World we treat our fellow citizens like this.

Even as a multi-millionaire this is the one reason I will not take a road trip around the USA!

Paul der Krake

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Re: What comes after the ACA?
« Reply #6719 on: March 15, 2021, 01:57:44 PM »
I have more faith in a large insurance company's ability to tell a hospital to cut the crap and charge roughly what they charge their in-network providers, than the individual.

Maybe that even leads to a national price list where everybody agrees on a ceiling for out-of-network providers. It can still be inflated compared to a normal in-network price, just not completely made up.

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Re: What comes after the ACA?
« Reply #6720 on: March 16, 2021, 10:48:15 PM »
Imagine laying on a gurney after a traffic accident 50 miles away from home and your biggest fear is how many thousands of $$ this is going to cost you... Its just outrageous in the wealthiest country in the World we treat our fellow citizens like this.

Even as a multi-millionaire this is the one reason I will not take a road trip around the USA!

As long as you have proper car insurance as well as standard medical insurance, there's functionally no reason to have insurance related agoraphobia. You can even add additional medical insurance to your car insurance (Personal Injury Protection) that will typically cover your entire out of pocket maximum, and often it's only $20-30/year for that added coverage since it is so rarely used in the first place. The US is a huge and beautiful country, I'd hate to see your living in paralysis over such a trivial thing to have added to your insurance coverage, especially if you're already very well off and at a time of life when you're still healthy enough to drive yourself.

pecunia

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Re: What comes after the ACA?
« Reply #6721 on: March 18, 2021, 09:12:16 AM »
People bitch bitch bitch and I'll bet most don't even bother to contact their representatives to get stuff changed for the better.  Maybe, just maybe folks deserve the bad health care.  They'll answer that it wouldn't do any good any way so why try.  That's the attitude.  Give up.

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Re: What comes after the ACA?
« Reply #6722 on: March 18, 2021, 11:24:24 AM »
People bitch bitch bitch and I'll bet most don't even bother to contact their representatives to get stuff changed for the better.  Maybe, just maybe folks deserve the bad health care.  They'll answer that it wouldn't do any good any way so why try.  That's the attitude.  Give up.

I'm feeling this way after hearing a sob story from my mom about how her coworker (who supported Trump) might have to legally divorce her now-totally-disabled-husband who never was able to get the medical care he needed, so that he can collect Medicaid. Anyway, the fact that he cheated on her while she was providing for the family wasn't enough- sounds like divorce is not desirable because they are super religious. At any rate, they are looking at paying $5k/week to put him in care facility and will lose their house.

Do these people ever think "hey, maybe if I didn't vote for the asshole who didn't give a sh!t about making healthcare affordable for all, there would be a better system in place for me!". I'm pretty sure anyone who doesn't actively advocate for major improvements to our healthcare system is asking for it at this point. The situation is that dire.

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Re: What comes after the ACA?
« Reply #6723 on: March 18, 2021, 01:36:32 PM »
Let me know how I can make a difference. I'm a Democrat in a blue state so my representatives are doing what I expect of them. What organizations are fighting to fix the broken for-profit medical system? I'm happy to donate time and money.

pecunia

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Re: What comes after the ACA?
« Reply #6724 on: March 18, 2021, 01:47:47 PM »
Let me know how I can make a difference. I'm a Democrat in a blue state so my representatives are doing what I expect of them. What organizations are fighting to fix the broken for-profit medical system? I'm happy to donate time and money.

Here's one:

https://www.healthcare-now.org/#

By the way - I am often one of the bitchers.  People like you who ACT are the ones to respect.

Omy

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Re: What comes after the ACA?
« Reply #6725 on: March 18, 2021, 02:23:41 PM »
Thank you!

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Re: What comes after the ACA?
« Reply #6726 on: March 18, 2021, 05:23:22 PM »
People bitch bitch bitch and I'll bet most don't even bother to contact their representatives to get stuff changed for the better.  Maybe, just maybe folks deserve the bad health care.  They'll answer that it wouldn't do any good any way so why try.  That's the attitude.  Give up.

I'm feeling this way after hearing a sob story from my mom about how her coworker (who supported Trump) might have to legally divorce her now-totally-disabled-husband who never was able to get the medical care he needed, so that he can collect Medicaid. Anyway, the fact that he cheated on her while she was providing for the family wasn't enough- sounds like divorce is not desirable because they are super religious. At any rate, they are looking at paying $5k/week to put him in care facility and will lose their house.

Do these people ever think "hey, maybe if I didn't vote for the asshole who didn't give a sh!t about making healthcare affordable for all, there would be a better system in place for me!". I'm pretty sure anyone who doesn't actively advocate for major improvements to our healthcare system is asking for it at this point. The situation is that dire.

https://apnews.com/article/us-news-henry-mcmaster-coronavirus-pandemic-medicaid-barack-obama-f7c83975db9e7cc4d6ff9dffd473cf26

Summary -the rescue plan covers 100% of medicaid expansion in those 12 states that STILL have chosen not to accept federal money to expand medicaid to the working poor -> states still refuse. This is 700 million-5 billion cash infusion into their states during times of historic unemployment, by the way.

Exflyboy

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Re: What comes after the ACA?
« Reply #6727 on: March 18, 2021, 07:08:32 PM »
I can hear the banjos from here!

pecunia

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Re: What comes after the ACA?
« Reply #6728 on: March 18, 2021, 08:44:45 PM »
Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

I thought it would be all Confederate states.  How can anyone be against helping sick people if the money is basically handed to them?  What kind of perverse strange principle can that be supporting?  I just don't understand the Republican mindset.  It neither makes moral nor economic sense. 

Of course it could be some sort of individual economics where their station in life is being helped by the medical industry.

Exflyboy

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Re: What comes after the ACA?
« Reply #6729 on: March 18, 2021, 09:11:08 PM »
Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

I thought it would be all Confederate states.  How can anyone be against helping sick people if the money is basically handed to them?  What kind of perverse strange principle can that be supporting?  I just don't understand the Republican mindset.  It neither makes moral nor economic sense. 

Of course it could be some sort of individual economics where their station in life is being helped by the medical industry.

I understand and sympathise (somewhat) with the R mindset. Growing up in post WW2 England where it really was pretty close to a "Socialist Hell hole". The unions ran the country and would literally call a nationwide strike of the coal miners at will and effectively shut the country down as the power went off.

Then came Maggie Thatcher and everything changed. A market based econoy flourished and I was fully on board with the idea of small government and the free market.

Of course it helped that I was caught up in a wave of rising prosperity.. I got a technical degree just as British industry was taking off!

I came to the US with exactly that mindset.. SO free market Republicanism?.. Count me in!

Then Bush happened.. Weapons of mass delusion, and eventually Trump.. OMG!... No.. just no!

What I just don't understand is what you are saying.. The little people who live in trailers with most of their teeth! Like McDowel County, West Virginia where the entire town is shut down because the coal mining company has simply up and left.

These people have really drunk the Kool-aid when it comes to viewing Communism as the ultimate evil that will surely happen a left of center President is elected.. Even though that has never happened in the history of the USA.

So these people vote directly against their own interests. That is quite bizarre
« Last Edit: March 19, 2021, 09:21:05 AM by Exflyboy »

reeshau

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Re: What comes after the ACA?
« Reply #6730 on: March 19, 2021, 04:04:58 AM »
Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

I thought it would be all Confederate states.  How can anyone be against helping sick people if the money is basically handed to them?  What kind of perverse strange principle can that be supporting?  I just don't understand the Republican mindset.  It neither makes moral nor economic sense. 

Of course it could be some sort of individual economics where their station in life is being helped by the medical industry.

It's not paid for.  It's partly paid for.  From the article:

"In Texas, the incentives would send the state about $5 billion over two years, and the state’s share of expanding coverage would be about $3.1 billion."  Texas' two-year budget is $113B, so this would be a nearly 3% budget increase.  And, if this follows the original ACA federal aid, it will eventually go away, so it's really an 8% budget increase, eventually.

I also note that 5 of those states have no income tax.  So where will the money come from?  Increased sales tax?  That would directly impact those you're trying to help.  Increased property tax?  That would be quite an indirect item--maybe its own line item?

I'm not saying I agree with it, and I don't excuse my state's recalcitrance.  But there is an interesting thread here where there is a different approach to taxation that makes it harder to "blend" in the costs.  Of course, 4 states with no income tax (Alaska, Nevada, New Hampshire, and Washington) figured it out.  Two of those states, though, have significant non-standard revenue sources.  In trying to understand it, I could see a point of view where this is essentially the reverse maneuver of the SALT tax limits--adding services to force the need for an income tax.
« Last Edit: March 19, 2021, 04:11:37 AM by reeshau »

maisymouser

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Re: What comes after the ACA?
« Reply #6731 on: March 19, 2021, 07:11:54 AM »
Let me know how I can make a difference. I'm a Democrat in a blue state so my representatives are doing what I expect of them. What organizations are fighting to fix the broken for-profit medical system? I'm happy to donate time and money.

Here's one:

https://www.healthcare-now.org/#

By the way - I am often one of the bitchers.  People like you who ACT are the ones to respect.

Thanks for the link! I have signed up. Calling/writing my reps just isn't doing it for me anymore and I figure it's time to get more involved.

jim555

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Re: What comes after the ACA?
« Reply #6732 on: March 19, 2021, 02:40:18 PM »
When the ACA Medicaid expansion started it was 100% Federal money for three years, which gradually dropped down to 90%.  These states had to come up with 0% to 10%.  The states will save money in other costs with the expansion, for example uncompensated care, which they pay for by the local taxpayer.  Catching illness early by having health screenings and avoiding the ER will save serious money.  It probably nets out to almost a push to have people covered.  Says a lot about a philosophy that will let people suffer needlessly.

Remember conservative Justice Roberts stepped into the law to give states the right to opt out.  It was never part of the original law.
« Last Edit: March 19, 2021, 02:43:25 PM by jim555 »

reeshau

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Re: What comes after the ACA?
« Reply #6733 on: March 19, 2021, 02:57:29 PM »
When the ACA Medicaid expansion started it was 100% Federal money for three years, which gradually dropped down to 90%.  These states had to come up with 0% to 10%.  The states will save money in other costs with the expansion, for example uncompensated care, which they pay for by the local taxpayer.  Catching illness early by having health screenings and avoiding the ER will save serious money.  It probably nets out to almost a push to have people covered.  Says a lot about a philosophy that will let people suffer needlessly.

Remember conservative Justice Roberts stepped into the law to give states the right to opt out.  It was never part of the original law.


That is interesting, as $5B vs. $3B isn't 90%.  The new deal is worse?  Wouldn't the holdout states just opt in to the original deal, then?

Again, I am not saying I agree with the decision--I am trying to see the point of view that would resist it.  I spent two years in Ireland--I certainly saw the benefits--and the limitations--of universal access.  Overall, I personally do see it as more humane.

jim555

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Re: What comes after the ACA?
« Reply #6734 on: March 19, 2021, 03:01:31 PM »
When the ACA Medicaid expansion started it was 100% Federal money for three years, which gradually dropped down to 90%.  These states had to come up with 0% to 10%.  The states will save money in other costs with the expansion, for example uncompensated care, which they pay for by the local taxpayer.  Catching illness early by having health screenings and avoiding the ER will save serious money.  It probably nets out to almost a push to have people covered.  Says a lot about a philosophy that will let people suffer needlessly.

Remember conservative Justice Roberts stepped into the law to give states the right to opt out.  It was never part of the original law.


That is interesting, as $5B vs. $3B isn't 90%.  The new deal is worse?  Wouldn't the holdout states just opt in to the original deal, then?

Again, I am not saying I agree with the decision--I am trying to see the point of view that would resist it.  I spent two years in Ireland--I certainly saw the benefits--and the limitations--of universal access.  Overall, I personally do see it as more humane.
I don't know exactly what you are referring to but here is my guess.  Elderly/disabled Medicaid is 50/50 split.  I know the Federal match for Elderly/disabled Medicaid has been temporarily increased due to the pandemic.  Expansion Medicaid has always been at least 90% or higher.

reeshau

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Re: What comes after the ACA?
« Reply #6735 on: March 19, 2021, 03:46:43 PM »
When the ACA Medicaid expansion started it was 100% Federal money for three years, which gradually dropped down to 90%.  These states had to come up with 0% to 10%.  The states will save money in other costs with the expansion, for example uncompensated care, which they pay for by the local taxpayer.  Catching illness early by having health screenings and avoiding the ER will save serious money.  It probably nets out to almost a push to have people covered.  Says a lot about a philosophy that will let people suffer needlessly.

Remember conservative Justice Roberts stepped into the law to give states the right to opt out.  It was never part of the original law.


That is interesting, as $5B vs. $3B isn't 90%.  The new deal is worse?  Wouldn't the holdout states just opt in to the original deal, then?

Again, I am not saying I agree with the decision--I am trying to see the point of view that would resist it.  I spent two years in Ireland--I certainly saw the benefits--and the limitations--of universal access.  Overall, I personally do see it as more humane.
I don't know exactly what you are referring to but here is my guess.  Elderly/disabled Medicaid is 50/50 split.  I know the Federal match for Elderly/disabled Medicaid has been temporarily increased due to the pandemic.  Expansion Medicaid has always been at least 90% or higher.



The AP article cited upthread:  https://apnews.com/article/us-news-henry-mcmaster-coronavirus-pandemic-medicaid-barack-obama-f7c83975db9e7cc4d6ff9dffd473cf26

Says:
"In Texas, the incentives would send the state about $5 billion over two years, and the state’s share of expanding coverage would be about $3.1 billion."

jim555

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Re: What comes after the ACA?
« Reply #6736 on: March 19, 2021, 04:04:11 PM »
When the ACA Medicaid expansion started it was 100% Federal money for three years, which gradually dropped down to 90%.  These states had to come up with 0% to 10%.  The states will save money in other costs with the expansion, for example uncompensated care, which they pay for by the local taxpayer.  Catching illness early by having health screenings and avoiding the ER will save serious money.  It probably nets out to almost a push to have people covered.  Says a lot about a philosophy that will let people suffer needlessly.

Remember conservative Justice Roberts stepped into the law to give states the right to opt out.  It was never part of the original law.


That is interesting, as $5B vs. $3B isn't 90%.  The new deal is worse?  Wouldn't the holdout states just opt in to the original deal, then?

Again, I am not saying I agree with the decision--I am trying to see the point of view that would resist it.  I spent two years in Ireland--I certainly saw the benefits--and the limitations--of universal access.  Overall, I personally do see it as more humane.
I don't know exactly what you are referring to but here is my guess.  Elderly/disabled Medicaid is 50/50 split.  I know the Federal match for Elderly/disabled Medicaid has been temporarily increased due to the pandemic.  Expansion Medicaid has always been at least 90% or higher.



The AP article cited upthread:  https://apnews.com/article/us-news-henry-mcmaster-coronavirus-pandemic-medicaid-barack-obama-f7c83975db9e7cc4d6ff9dffd473cf26

Says:
"In Texas, the incentives would send the state about $5 billion over two years, and the state’s share of expanding coverage would be about $3.1 billion."
They are giving 5% more match for regular (Elderly/Disabled) Medicaid if they expand.  So that will more than cover the costs for 2 years of expansion.  "Bidencare" is supposed to address the gap, but that hasn't been introduced yet so we will see.

Geographer

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Re: What comes after the ACA?
« Reply #6737 on: April 14, 2021, 01:48:38 PM »
Question regarding enrollment... I'm leaving my job next month and plan to enroll in ACA coverage at the end of my 60 day COBRA eligibility window. However, I don't know where I'll be at that time but want to end up in Florida. Is the state residence based on where you are currently located at the time? Can it be changed if you move?

It's complicated for me because I'm currently living abroad, my most recent state domicile is Virginia (although I never plan on staying/living there again), I want to stay with my parents for a month or so in New York state, but ultimately end up in Florida at some point but have no timeline. Advice appreciated!

Paul der Krake

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Re: What comes after the ACA?
« Reply #6738 on: April 14, 2021, 01:59:26 PM »
It's complicated and something you need to stay on top of.

Generally speaking, the marketplace doesn't really require any real verification of residency. They just want an address to send enrollment packets to in the county where you say you will be located. I was able to enroll in my new state ACA coverage before getting a driver's license or even signing long-term lease.

The other thing to realize is that moving to another county is by definition a special enrollment period. You could theoretically move every couple weeks and get new coverage every time. In practice, because the paperwork isn't instant, you want to stay ahead of the curve.

In your shoes, I'd skip the NY coverage (riding the COBRA 60 day lookup you alluded to), and apply for FL coverage right as you're getting ready to move. Enrollment is usually only possible at the start of the month, so if you plan on getting coverage starting, say, July 1, apply in early June and stay on top of it.

chasesfish

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Re: What comes after the ACA?
« Reply #6739 on: April 14, 2021, 02:30:08 PM »
Question regarding enrollment... I'm leaving my job next month and plan to enroll in ACA coverage at the end of my 60 day COBRA eligibility window. However, I don't know where I'll be at that time but want to end up in Florida. Is the state residence based on where you are currently located at the time? Can it be changed if you move?

It's complicated for me because I'm currently living abroad, my most recent state domicile is Virginia (although I never plan on staying/living there again), I want to stay with my parents for a month or so in New York state, but ultimately end up in Florida at some point but have no timeline. Advice appreciated!

The biggest issue you'll likely have is where is your provider network.  For the most part, you're going to be limited to a network that's domiciled in the state you get coverage.  Very few ACA plans have a nationwide network.

Choose the state you'll most likely spend the majority of the year in.  You're only going to get emergency coverage out of state

JGS1980

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Re: What comes after the ACA?
« Reply #6740 on: April 14, 2021, 02:35:50 PM »
It's complicated and something you need to stay on top of.

Generally speaking, the marketplace doesn't really require any real verification of residency. They just want an address to send enrollment packets to in the county where you say you will be located. I was able to enroll in my new state ACA coverage before getting a driver's license or even signing long-term lease.

The other thing to realize is that moving to another county is by definition a special enrollment period. You could theoretically move every couple weeks and get new coverage every time. In practice, because the paperwork isn't instant, you want to stay ahead of the curve.

In your shoes, I'd skip the NY coverage (riding the COBRA 60 day lookup you alluded to), and apply for FL coverage right as you're getting ready to move. Enrollment is usually only possible at the start of the month, so if you plan on getting coverage starting, say, July 1, apply in early June and stay on top of it.

Paul and Geographer, did Florida ever even expand Medicaid for the ACA? 

https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

If not, Geographer will need to rethink his health care insurance needs.

JGS

Paul der Krake

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Re: What comes after the ACA?
« Reply #6741 on: April 14, 2021, 05:17:07 PM »
It's complicated and something you need to stay on top of.

Generally speaking, the marketplace doesn't really require any real verification of residency. They just want an address to send enrollment packets to in the county where you say you will be located. I was able to enroll in my new state ACA coverage before getting a driver's license or even signing long-term lease.

The other thing to realize is that moving to another county is by definition a special enrollment period. You could theoretically move every couple weeks and get new coverage every time. In practice, because the paperwork isn't instant, you want to stay ahead of the curve.

In your shoes, I'd skip the NY coverage (riding the COBRA 60 day lookup you alluded to), and apply for FL coverage right as you're getting ready to move. Enrollment is usually only possible at the start of the month, so if you plan on getting coverage starting, say, July 1, apply in early June and stay on top of it.

Paul and Geographer, did Florida ever even expand Medicaid for the ACA? 

https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

If not, Geographer will need to rethink his health care insurance needs.

JGS
I don't follow. Lack of medicaid expansion is a problem for people in the "expansion" range of the federal poverty line. I see no indication in Geographer's post that he falls in that category (it's a really, really low income). What am I missing?

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Re: What comes after the ACA?
« Reply #6742 on: April 14, 2021, 05:26:15 PM »
Yeah. I would say that it's a bad idea to live in a non-expansion state if you plan to have your income be below the poverty line. The ACA premium tax credits are only available at or above 100% of the poverty level. That aside, you'll be able to get some coverage wherever you go.

Geographer

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Re: What comes after the ACA?
« Reply #6743 on: April 15, 2021, 12:43:40 PM »
Well my total earned income this year will be around $40k or so when I quit my job in May. And then for next year if I'm still not working it'll probably be whatever I convert to Roth while staying under the limit for 0% long term capital gains in taxable brokerage. So it'll definitely be kept under $40k but I'll have some control over that.

Can I enroll in advance for the plan prior to moving there, if I know where I'll be going?

JGS1980

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Re: What comes after the ACA?
« Reply #6744 on: April 15, 2021, 12:55:57 PM »
Well my total earned income this year will be around $40k or so when I quit my job in May. And then for next year if I'm still not working it'll probably be whatever I convert to Roth while staying under the limit for 0% long term capital gains in taxable brokerage. So it'll definitely be kept under $40k but I'll have some control over that.

Can I enroll in advance for the plan prior to moving there, if I know where I'll be going?

https://www.benefits.gov/benefit/1625#:~:text=To%20be%20eligible%20for%20Florida,income%20or%20very%20low%20income.

pecunia

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Re: What comes after the ACA?
« Reply #6745 on: April 15, 2021, 08:38:25 PM »
A lot of the folks who post here are bright creative people.  By limiting their income, they are also limiting a contribution to Society.  I'm just thinking it's sad that their contribution has to be stifled in order to just see a doctor in an affordable manner.  But, we all know the health care system is a snarled up mess not designed to truly serve the population.

Will it be another generation before this clusterf*ck is fixed?

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Re: What comes after the ACA?
« Reply #6746 on: April 16, 2021, 01:23:54 PM »
A lot of the folks who post here are bright creative people.  By limiting their income, they are also limiting a contribution to Society.

Are we though? I do quite a bit of volunteering in lieu of having a higher income. The benefit of this is pretty easy to see. The societal benefit of what I could be doing to earn a higher income (probably just helping a corporation make a bit more money) is much murkier.

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Re: What comes after the ACA?
« Reply #6747 on: April 16, 2021, 02:10:53 PM »
Going to work every day is seriously limiting my contribution to society on a creative and intellectual level.  It's likely that retirement will change that for the better.

pecunia

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Re: What comes after the ACA?
« Reply #6748 on: April 16, 2021, 03:17:11 PM »
Good points - I hadn't thought of it that way.  The value to Society is not to be measured only in money.

Omy

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Re: What comes after the ACA?
« Reply #6749 on: April 16, 2021, 04:05:57 PM »
Another societal benefit of retiring early is freeing up high paying jobs for the next generation.