Author Topic: What comes after the ACA?  (Read 408400 times)

Metric Mouse

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Re: What comes after the ACA?
« Reply #350 on: January 12, 2017, 02:02:59 PM »

I think basic healthcare is in the same category, and should be paid for the same way.
I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.

I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.
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Re: What comes after the ACA?
« Reply #351 on: January 12, 2017, 02:04:18 PM »

I think basic healthcare is in the same category, and should be paid for the same way.
I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.

I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.

That's a really good point, hadn't thought of that distinction before.

rpr

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Re: What comes after the ACA?
« Reply #352 on: January 12, 2017, 02:10:07 PM »
I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.
I wholeheartedly agree with what you say. However, given the current political anti-government atmosphere prevailing in this country, universal health insurance is the best that we can hope for. It is certainly better than the alternative of no health insurance thus no health care.

EfficientN

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Re: What comes after the ACA?
« Reply #353 on: January 12, 2017, 02:18:37 PM »
I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

Wait, isn't what you're describing just a High-Deductible Health Care Plan? Those are freely available and even come with generous HSA tax incentives.

mathlete

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Re: What comes after the ACA?
« Reply #354 on: January 12, 2017, 02:24:15 PM »
You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.

You pay the maximum of the set penalty and a percentage of your income, all the way up to the cost of a Bronze AV plan. So it can be a lot higher than $695. For a sufficiently high income, you're basically forced onto a bronze plan.

Besides, you don't need to be that rich to have your options of cost-cutting limited by ACA.

I receive employer coverage so this is moot for me, but if I didn't have employer coverage, but made a similar income and had similar savings to what I do now, I would opt for a very high out of pocket max plan. I'm a young and healthy guy with enough savings to cover lots of healthcare costs. This strategy is hampered by such a plan possibly not meeting the minimum AV. I'd be discouraged from doing this b/c of the penalty.

mathlete

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Re: What comes after the ACA?
« Reply #355 on: January 12, 2017, 02:33:57 PM »
Wait, isn't what you're describing just a High-Deductible Health Care Plan? Those are freely available and even come with generous HSA tax incentives.

A high deductible plan is one way to do it. Critical illness plans like I mentioned are another.

Even with high deductible plans though, under ACA, you're really limited by how "high" the high deductible can be.

In order to qualify as a QHP (plan that will get you out of paying the penalty), a plan has to meet certain limits. One limit is on the out-of-pocket max. Deductible can't be higher than the OOP max so your deductible is capped at $7,150 for individuals.


protostache

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Re: What comes after the ACA?
« Reply #356 on: January 12, 2017, 02:57:55 PM »
You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.

You pay the maximum of the set penalty and a percentage of your income, all the way up to the cost of a Bronze AV plan. So it can be a lot higher than $695. For a sufficiently high income, you're basically forced onto a bronze plan.

Besides, you don't need to be that rich to have your options of cost-cutting limited by ACA.

I receive employer coverage so this is moot for me, but if I didn't have employer coverage, but made a similar income and had similar savings to what I do now, I would opt for a very high out of pocket max plan. I'm a young and healthy guy with enough savings to cover lots of healthcare costs. This strategy is hampered by such a plan possibly not meeting the minimum AV. I'd be discouraged from doing this b/c of the penalty.

I didn't know it applied like that. Good info.

That said, the number of people this affects is maaaaybe 1% of the population on the outside, right? There just aren't that many people that actually have the financial wherewithal to self insure things a non-QHP indemnity plan doesn't cover. Public policy needs to account for most of the people most of the time. It shouldn't be catering to the top.
« Last Edit: January 12, 2017, 03:01:43 PM by protostache »

RangerOne

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Re: What comes after the ACA?
« Reply #357 on: January 12, 2017, 03:35:31 PM »
Which preferential tax treatment are you referring to?

Employers do not pay FICA on benefits paid to employees - that's a ~8% savings off the top. It's also the case that the employer can deduct any benefits paid out as a business expense - but the employee can do no such thing if they obtain insurance on their own.

Hence the incentive is for employers to pay as much as possible in the form of benefits, and as little as possible in salary, in many cases.

-W

Hm okay that is kind of what I assumed you were getting at though I don't have the perspective of the employer end to understand why you think that tax incentive is harmful.

It sounds like you are suggesting that having big companies disproportionately encourage through tax breaks to pay untenable health care premiums is driving up prices which would otherwise be lower if it were left entirely to individual families to pay for.

That is an interesting notion I hadn't considered. Have you seen any research that shows this is happening? Maybe this is based on personal experience from helping make such decisions?

I don't get the impression from larger companies and employment groups like Tri-net, based the raw cost of their health care plans and the portion they pay for, that they find it desirable to spend as much money as possible on health insurance. Many appear to be going the opposite direction. There are many large companies trying to shift plans over to HDHP over standard plans primarily because they cost them less.

Its not like you can pay an employee in a competitive market half what your competitors are by arguing the other half is covered by an overpriced health plan that is more than you need. Competition among employers should keep the total package prices in line. You can certainly argue that your offer is better because you offer better more valuable health care than a competitor but there is a definite limit on how effective that argument will be based on many other market factors beyond tax incentives.

RangerOne

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Re: What comes after the ACA?
« Reply #358 on: January 12, 2017, 04:02:55 PM »
...
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage....

I don't know if you have taken a recent model car to a shop lately but the age of a fender bender costing you $600 dollars out of pocket seems long gone. I recently took in my 2013 Hyundai Sonata for a parking lot hit and run. It is our nice family car so cosmetics still mean something to me.

Basically someone crunched a small part of our bumper behind the rear wheel. Caving in maybe like a soccer ball sized dent, but functionally no real damage.

Parts and paint cost maybe like $80 for the repair. But the man hours to fix the dent cost over $2000 and took nearly a full week of work by an approved AAA repair vendor... From what I have read newer vehicles, due to the use of modern body materials, aren't able to undergo many of the same simple quick fixes that cars pre and early 2000 era used to be able to get. Fender benders have gotten pretty damn expensive.

I could pay $2000 cash to fix something like this, but it is one hell of a price to pay for a cosmetic fix over random uncontrollable damage occasionally incurred in city living wiht assholes.
I don't dispute what you say, but I don't see how it invalidates my point. The majority of accidents are non-injury fender benders.  Certainly in late-model cars they can cost a few grand to fix should you want to.
My point was that the majority of accidents (even at ~$2k) are not the true reason to be insured.  It's the less common but more severe accidents that can be orders of magnitude more costly, like multiple-car injury accidents.
All of this was an analogy to another poster's comment about the median ER visit cost being ~$1,200, and how that wasn't exactly a financial catastrophy, so why the need for insurance?

Thats true I suppose discussing real numbers doesn't make your point invalid.

I think what you are stating is one way of looking at what insurance is. But I don't think that is how most people think when they buy insurance.

What I think actually happens is you buy insurance to set a threshold that says, I can afford to risk losing X amount of cash each year without any lingering adverse effects. And I am willing to pay Y fixed cost per year to make sure I never go over Y+X in any given year.

You aren't really shopping for insurance thinking about the 1 in a million chance you will be hospitalized for a major issue for plow your car into a pack of Teslas.

What you are doing is trying to control your budget by setting a maximum yearly cost you will incur by always paying a fixed insurance cost. This allows you hopefully to be able to say that with regards to something like yearly health costs, you are equally comfortable paying the minimum and maximum each year. Without insurance there would be almost no way to have this kind of certainty.

I don't know maybe I am saying the same thing. Maybe there is not a difference between talking about being insured for catastrophe and being insured to set tolerable max and min cost on your health.

waltworks

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Re: What comes after the ACA?
« Reply #359 on: January 12, 2017, 04:29:56 PM »
Don't get me wrong, Ranger - the employer still wants to spend as little as possible on health insurance, of course. But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary. That's the issue here.

It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

Essentially, decoupling health care from employment should be a goal for basically everyone regardless of political persuasion. Even simply applying FICA to all compensation would do that pretty quickly and a true market for individual insurance could develop.

-W

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Re: What comes after the ACA?
« Reply #360 on: January 12, 2017, 04:39:57 PM »
Don't worry it will be wonderful and so much cheaper!  How?  Magic!

protostache

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Re: What comes after the ACA?
« Reply #361 on: January 12, 2017, 04:40:41 PM »
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.

nereo

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Re: What comes after the ACA?
« Reply #362 on: January 12, 2017, 05:09:41 PM »
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.
For Trump you forgot the "fantastic" part of his detailed plan.

Re: Ryan's plan... is that seriously what it's called (A Better Way)?  Did no one think that through??  I mean, I get that they are immediately trying to suggest that it's better than Obamacare, but what happens if it actually goes through?  For the foreseeable future people are political hacks are going to be saying "is this really 'A Better Way'" and "there's got to be "A Better Way"".  Why not just label is the "Independently Tested Standardized Universal Care & Karma Statute?"??
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protostache

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Re: What comes after the ACA?
« Reply #363 on: January 12, 2017, 05:37:22 PM »
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.
For Trump you forgot the "fantastic" part of his detailed plan.

Re: Ryan's plan... is that seriously what it's called (A Better Way)?  Did no one think that through??  I mean, I get that they are immediately trying to suggest that it's better than Obamacare, but what happens if it actually goes through?  For the foreseeable future people are political hacks are going to be saying "is this really 'A Better Way'" and "there's got to be "A Better Way"".  Why not just label is the "Independently Tested Standardized Universal Care & Karma Statute?"??

Yep. It even has a slick marketing website: http://abetterway.speaker.gov. Keep in mind this is Ryan's comprehensive plan for A Better America so it includes things like A Better Medicare (gotten rid of) and A Better Social Security (also gone).

nereo

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Re: What comes after the ACA?
« Reply #364 on: January 12, 2017, 05:42:11 PM »
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.
For Trump you forgot the "fantastic" part of his detailed plan.

Re: Ryan's plan... is that seriously what it's called (A Better Way)?  Did no one think that through??  I mean, I get that they are immediately trying to suggest that it's better than Obamacare, but what happens if it actually goes through?  For the foreseeable future people are political hacks are going to be saying "is this really 'A Better Way'" and "there's got to be "A Better Way"".  Why not just label is the "Independently Tested Standardized Universal Care & Karma Statute?"??

Yep. It even has a slick marketing website: http://abetterway.speaker.gov. Keep in mind this is Ryan's comprehensive plan for A Better America so it includes things like A Better Medicare (gotten rid of) and A Better Social Security (also gone).
so.... most of the "better" things are already gone? 
how sad.
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brooklynguy

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Re: What comes after the ACA?
« Reply #365 on: January 12, 2017, 05:45:15 PM »
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

protostache

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Re: What comes after the ACA?
« Reply #366 on: January 12, 2017, 05:48:37 PM »
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Plus the employer half of payroll tax. One could argue that's part of compensation, I suppose.

nereo

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Re: What comes after the ACA?
« Reply #367 on: January 12, 2017, 06:03:19 PM »
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Exactly, and I think this is an example of an unexpected runaway effect. We wanted to encourage employers to provide benefits for their workers, so we made it preferable for companies to provide health insurance over increased pay.  Unanticipated result - people stopped recognizing what their health care premiums actually cost, and it created barriers to leaving (I don't want to lose my health care!) Insurance companies got savvy and started bargaining for better prices, which alternatively meant that self-insured people had to pay more for the same treatment. Now whenever people become unemployed they are unprepared to pay their own insurance. "$15,000/year for a low-deductable family plan? that's outrageous!" - maybe, but it's about what your health insurance cost all along...
« Last Edit: January 12, 2017, 06:54:10 PM by nereo »
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protostache

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Re: What comes after the ACA?
« Reply #368 on: January 12, 2017, 06:14:38 PM »
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Exactly, and I think this is an example of an unexpected runaway effect. We wanted to encourage employers to provide benefits for their workers, so we made it preferable for companies to provide health insurance over increased pay.  Unanticipated result - people stopped recognizing what their health care premiums actually cost, and it created barriers to leaving (I don't want to lose my health care!) Insurance companies got savvy and started bargaining for better prices, which alternatively meant that self-insured people had to pay more for the same treatment. Now whenever people become unemployed they are unprepared to pay their own insurance. "$5,000/year for a low-deductable family plan? that's outrageous!" - maybe, but it's about what your health insurance cost all along...

I don't think society encouraged it. Companies couldn't raise wages after WWII so they started offering insane fringe benefits instead, which they then wrote off their taxes as expenses. Company provided health insurance is a legacy from that era.

Also $5,000 for a low deductible family plan? That's outrageous...ly low. The low deductible plans in Michigan this year were on the order of $18k this year.

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Re: What comes after the ACA?
« Reply #369 on: January 12, 2017, 06:15:38 PM »
I don't get the impression from larger companies and employment groups like Tri-net, based the raw cost of their health care plans and the portion they pay for, that they find it desirable to spend as much money as possible on health insurance. Many appear to be going the opposite direction. There are many large companies trying to shift plans over to HDHP over standard plans primarily because they cost them less.

Its not like you can pay an employee in a competitive market half what your competitors are by arguing the other half is covered by an overpriced health plan that is more than you need. Competition among employers should keep the total package prices in line. You can certainly argue that your offer is better because you offer better more valuable health care than a competitor but there is a definite limit on how effective that argument will be based on many other market factors beyond tax incentives.

Because many employers have figured out they can shift the cost burden to employees without giving them the corresponding bump in pay they would hypothetically see instead of healthcare subsidies.
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thenextguy

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Re: What comes after the ACA?
« Reply #370 on: January 12, 2017, 06:23:40 PM »
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

I have no idea. But Donald Trump says it'll be "terrific!"

Quidnon?

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Re: What comes after the ACA?
« Reply #371 on: January 12, 2017, 06:33:34 PM »
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

I have no idea. But Donald Trump says it'll be "terrific!"

I believe that is a mis-quote.  Trump said it was going to be "Yuge!"
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rpr

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Re: What comes after the ACA?
« Reply #372 on: January 12, 2017, 06:45:01 PM »
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

I have no idea. But Donald Trump says it'll be "terrific!"

I believe that is a mis-quote.  Trump said it was going to be "Yuge!"
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nereo

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Re: What comes after the ACA?
« Reply #373 on: January 12, 2017, 06:56:36 PM »
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Exactly, and I think this is an example of an unexpected runaway effect. We wanted to encourage employers to provide benefits for their workers, so we made it preferable for companies to provide health insurance over increased pay.  Unanticipated result - people stopped recognizing what their health care premiums actually cost, and it created barriers to leaving (I don't want to lose my health care!) Insurance companies got savvy and started bargaining for better prices, which alternatively meant that self-insured people had to pay more for the same treatment. Now whenever people become unemployed they are unprepared to pay their own insurance. "$5,000/year for a low-deductable family plan? that's outrageous!" - maybe, but it's about what your health insurance cost all along...

I don't think society encouraged it. Companies couldn't raise wages after WWII so they started offering insane fringe benefits instead, which they then wrote off their taxes as expenses. Company provided health insurance is a legacy from that era.

Also $5,000 for a low deductible family plan? That's outrageous...ly low. The low deductible plans in Michigan this year were on the order of $18k this year.

What I meant by 'encouraged' was exacly that - through the tax code.  I don't think it was ever intended to turn out this way (hence the 'unexpected consequences') but our tax code encouraged employers to offer health care in lieu of bigger paychecks which started this cycle of people being dependent on their employer-sponsored health care and not understanding the total cost.

oh - i meant for it to be "$15,000" - that was a typo, thanks for the catch.
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Re: What comes after the ACA?
« Reply #374 on: January 13, 2017, 04:27:22 AM »
Don't get me wrong, Ranger - the employer still wants to spend as little as possible on health insurance, of course. But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary. That's the issue here.

It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

Essentially, decoupling health care from employment should be a goal for basically everyone regardless of political persuasion. Even simply applying FICA to all compensation would do that pretty quickly and a true market for individual insurance could develop.

-W

Yeah, I never understood why the ACA included the mandate for employers over a certain size to provide insurance for their employees.  If you want the exchanges to succeed, you should try to give them as many customers as possible, rather than making it even more likely that all of the low-risk customers get insurance through some source other than the exchanges.  I presume that the eventual Republican replacement will not include an employer mandate, which might actually be a step in the right direction toward a viable individual insurance market (although it will be disruptive in the short term when a bunch of people lose their employer-provided health insurance).
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mm1970

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Re: What comes after the ACA?
« Reply #375 on: January 13, 2017, 10:10:45 AM »
I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.
Well, no but I think there might be just a basic philosophical difference in the point of insurance.

When I was a kid (back in the dark ages), we didn't have insurance for much of the time.  However, it was expected that you paid for your doctors and dentist appointments.  Now the good and bad on that:
Good: you budgeted for this.  Paying for your own medical care came before cable TV, eating out, computers, new clothing, vacations, etc.  (some of these items were just coming out when I was growing up)
Bad: during lean times, you went to the dentist every 2-3 years and the doctor less frequently than that.  Teeth are very important and dental hygiene is really important to health.

So it was expected that you covered the basics, and insurance (if you had it), covered the big stuff.  (I had to have surgery twice when I was 12, no insurance, my parents paid that off for 5 years).


Now, other philosophy: an ounce of prevention is worth a pound of cure.
For whatever reason, people don't go to the doctor when they are ailing.  For some (even people my age), they would get mad at a copay for an annual exam.  The whole cost sharing thing was an affront, and these are upper middle class people.
For others, they just can't afford it.  A $25 copay?  No money for that.  So the problems are left to get worse.  Infections.  Bad teeth.  High cholesterol.  Pre-diabetes.  Wait long enough and you have very very expensive, bad problems.

The good thing about the ACA is that preventive things are fully covered.  So if it really does result in people going to the doctor, getting diagnosed, and fixing things before they get worse, then it is worth it in the long run.

For me, I fall in a gray area.  I totally understand the point of expecting people to use insurance for catastrophic things only.  On the other hand, insurance companies suck and deny deny deny - I really don't think people should die because they cannot afford insurance and treatment, and I also don't think people should be bankrupted due to health / medical issues (I also believe we spend too much on treatment.)


Helvegen

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Re: What comes after the ACA?
« Reply #376 on: January 13, 2017, 01:35:35 PM »
It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

I work for megacorp and every year, they send out information sheets detailing how much they pay for their share of employee benefits. Their share of my HDHP coverage is $21k. Then you add on what I pay, about another $3k, so $24k a year in family plan coverage. Yeah, not affording that on my own.

rpr

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Re: What comes after the ACA?
« Reply #377 on: January 13, 2017, 02:41:29 PM »
It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

I work for megacorp and every year, they send out information sheets detailing how much they pay for their share of employee benefits. Their share of my HDHP coverage is $21k. Then you add on what I pay, about another $3k, so $24k a year in family plan coverage. Yeah, not affording that on my own.

In addition:

If this was not tax deductible, you would be paying 6K/year in federal taxes assuming 25% tax bracket. Most people with employer health insurance don't realize the tax break (or subsidy) they are getting from the government.

realDonaldTrump

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Re: What comes after the ACA?
« Reply #378 on: January 15, 2017, 04:56:18 AM »
Short answer is: "Something Terrific"

GuitarStv

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Re: What comes after the ACA?
« Reply #379 on: January 15, 2017, 08:38:46 AM »
Short answer is: "Something Terrific"

I suspect people would be less concerned if the long answer differed in any way from the short answer.

AllTheLights

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Re: What comes after the ACA?
« Reply #380 on: January 15, 2017, 08:49:27 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

realDonaldTrump

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Re: What comes after the ACA?
« Reply #381 on: January 15, 2017, 09:00:34 AM »

I suspect people would be less concerned if the long answer differed in any way from the short answer.

The long answer is it will be disaster for poor people (many of them Trump voters).  But it will take to those Rednecks 1-2 years to realize that they voted against their own interest.

Donald Trump is very smart just ask him so hes a quick learner.

GuitarStv

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Re: What comes after the ACA?
« Reply #382 on: January 15, 2017, 09:05:37 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

Hyper-individualism and the myth of personal exceptionalism appear to be very heavily sold to the average American, and I believe that they act as roadblocks to viewing the question the way the rest of the world does.
« Last Edit: January 15, 2017, 12:49:48 PM by GuitarStv »

nereo

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Re: What comes after the ACA?
« Reply #383 on: January 15, 2017, 09:30:18 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

I agree partly with GuitarStv that the concept of total universal healthcare is anathema to most Americans.  For starters, it's socialism, something that a great percentage of our current population grew up to fear and hate.  Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.  YOu can hear that in the way we talk about the government; it's rarely "OUR government is making it harder for small businesses to succeed" - instead it's "THE government (often just "Washington" is against US small business owners".  Even though we are supposedly a government of the people, for the people and by the people we've never fully trusted our elected officials.

FInally there's great concern about financing other people's health care costs, especially those that make poor life decisions. I'll say this is a concern I share in Canada, where people who are overweight, smoke and don't excercise get the same access to health care that I do. With (usually) zero out of pocket cost to everyone the healthy use less than the sick.

THen of course there's the free-market capitalism mentality that permeates US society and runs something like this: why should someone who's worked hard to be very successful be treated the same as a deadbeat slacker when they go to the go to doctors?  In that context, shouldn't having more and paying more result in better/faster/more comfortable service?

Personal thoughts: I think both the Canadian-provincial and US health care systems have a lot of room for improvement.
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Roland of Gilead

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Re: What comes after the ACA?
« Reply #384 on: January 15, 2017, 07:36:39 PM »

FInally there's great concern about financing other people's health care costs, especially those that make poor life decisions. I'll say this is a concern I share in Canada, where people who are overweight, smoke and don't excercise get the same access to health care that I do. With (usually) zero out of pocket cost to everyone the healthy use less than the sick.


I feel kind of the same way about people who make poor education choices.  Women's studies in college instead of a good solid engineering degree.   They then can't pay back their student loans because there actually was no demand for their field of study.

People make bad choices.

waltworks

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Re: What comes after the ACA?
« Reply #385 on: January 15, 2017, 07:39:45 PM »

FInally there's great concern about financing other people's health care costs, especially those that make poor life decisions. I'll say this is a concern I share in Canada, where people who are overweight, smoke and don't excercise get the same access to health care that I do. With (usually) zero out of pocket cost to everyone the healthy use less than the sick.


I feel kind of the same way about people who make poor education choices.  Women's studies in college instead of a good solid engineering degree.   They then can't pay back their student loans because there actually was no demand for their field of study.

People make bad choices.

Actually most of the student loan defaults are from folks who dropped out - and of those, most are in 2-year/associates programs. It's really not the Swarthmore underwater feminist basket weaving kids - they just end up getting a real job and do fine and eventually pay off the loans.

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Metric Mouse

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Re: What comes after the ACA?
« Reply #386 on: January 15, 2017, 10:55:24 PM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

No one's really presented a workable, affordable plan for moving towards this. And it would probably require cutting several popular programs (as it would replace them) of medicare and medicaid, which causes many people to oppose it.

Give me one fine day of plain sailing weather and I can mess up anything.

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Re: What comes after the ACA?
« Reply #387 on: January 16, 2017, 05:23:59 AM »
If the ACA is defunded but the law remains on the books, then most people would qualify for a hardship exemption due to unaffordability.  The ACA catastrophic plans would then become an option.  This seems like the most likely outcome.  There will be no replacement since they do not have the votes for one.  They will do a delayed defunding.


NoStacheOhio

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Re: What comes after the ACA?
« Reply #388 on: January 16, 2017, 05:43:31 AM »
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.
« Last Edit: January 16, 2017, 06:09:12 AM by NoStacheOhio »
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

nereo

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Re: What comes after the ACA?
« Reply #389 on: January 16, 2017, 05:55:50 AM »
Something that just came up in a WaPo article, that I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.

Yeah... the ACA is filled with problems, but what it replaced in 2006 was far worse. I'd respect opponents a lot more if they'd just admit that.  Then the decision could be either
1) the ACA was a first attempt, but it's so big/cumbersome that we should write an entirely new law
2) the ACA's faults can be fixed by numerous 'patches'

Framed that way I can see merit for option #1.... but that involves first admitting the ACA was an improvement over our previous system. Instead, it's been made out to be the devil's spawn.
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Iplawyer

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Re: What comes after the ACA?
« Reply #390 on: January 16, 2017, 07:12:39 AM »
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.

And before the ACA women only bore the cost of pregnancy when buying health insurance - not the men that were an integral part of it.  So insurance was far more expensive for women than men and impossible to get once pregnant.  Yay - let's have women go nine months with no prenatal care and birth a baby in the emergency room. As a society - just like society pays for primary and secondary education - can't we agree that all of us should pay for insurance for a pregnant woman? 

NoStacheOhio

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Re: What comes after the ACA?
« Reply #391 on: January 16, 2017, 07:50:54 AM »
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.

And before the ACA women only bore the cost of pregnancy when buying health insurance - not the men that were an integral part of it.  So insurance was far more expensive for women than men and impossible to get once pregnant.  Yay - let's have women go nine months with no prenatal care and birth a baby in the emergency room. As a society - just like society pays for primary and secondary education - can't we agree that all of us should pay for insurance for a pregnant woman?

The kicker is that we're all paying for it anyway, regardless of the insurance situation. Woman has a baby in the ER with no insurance and no assets? Guess who's bill just got a little bit higher? If it's a non-profit hospital, they get to count any "bad debt" as "community benefit" for the IRS, even after putting the patient into collections/bankruptcy.

The care is generally happening one way or another, but acting like we aren't paying for it (or aren't going to pay for it) is just asinine. We need to move past it, and develop something sustainable that doesn't involve dicking over poor people.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #392 on: January 16, 2017, 07:53:42 AM »
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.

And before the ACA women only bore the cost of pregnancy when buying health insurance - not the men that were an integral part of it.  So insurance was far more expensive for women than men and impossible to get once pregnant.  Yay - let's have women go nine months with no prenatal care and birth a baby in the emergency room. As a society - just like society pays for primary and secondary education - can't we agree that all of us should pay for insurance for a pregnant woman?

The kicker is that we're all paying for it anyway, regardless of the insurance situation. Woman has a baby in the ER with no insurance and no assets? Guess who's bill just got a little bit higher? If it's a non-profit hospital, they get to count any "bad debt" as "community benefit" for the IRS, even after putting the patient into collections/bankruptcy.

The care is generally happening one way or another, but acting like we aren't paying for it (or aren't going to pay for it) is just asinine. We need to move past it, and develop something sustainable that doesn't involve dicking over poor people.

Amen brother, or, I guess I should say +1.  I would only add that it disproportionately affects the 'middle class' as opposed to being a problem for the 1%. 
« Last Edit: January 16, 2017, 08:18:09 AM by EscapeVelocity2020 »
Transitioning to FIRE'd albeit somewhat cautiously...

packlawyer04

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Re: What comes after the ACA?
« Reply #393 on: January 16, 2017, 08:43:53 AM »
There is still no plan anywhere to comprehensively address medical costs so there is still no solution that works (ACA or any other plan put forth to date from republicans).

Nobody wants to address the difficult questions.  Just like other problems, keep kicking the can down the road.

packlawyer04

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Re: What comes after the ACA?
« Reply #394 on: January 16, 2017, 08:48:10 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

sol

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Re: What comes after the ACA?
« Reply #395 on: January 16, 2017, 09:07:35 AM »
The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Technically we have three different single payer systems.  Medicaid, Medicare, and Tricare. I agree that they do not all work equally well, but I would argue that all three of them are better than what we had before the ACA.
« Last Edit: January 16, 2017, 09:10:55 AM by sol »

nereo

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Re: What comes after the ACA?
« Reply #396 on: January 16, 2017, 09:08:05 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.
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infogoon

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Re: What comes after the ACA?
« Reply #397 on: January 16, 2017, 09:16:11 AM »
To provide the defense of what for its citizens?  You mean, like, their health?

It's fucking amazing that there are people in this country more scared of ISIS than they are of cancer.

protostache

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Re: What comes after the ACA?
« Reply #398 on: January 16, 2017, 09:31:53 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.

nereo

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Re: What comes after the ACA?
« Reply #399 on: January 16, 2017, 09:47:06 AM »
interesting article out today commenting on DJT's pledge of 'insurance for everybody'.

tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'. He says it will not have cuts to Medicare.
Curious to see how this could happen without costing a fortune and requiring some sort of coersion/mandate to get everyone to participate.
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