What comes after the ACA?

[fuzzy math]

10,000 deductible and max OOP. Plus I get a deduction for my HSA contribution.
  I think a certain amount of deductible is desirable to eliminate nuisance doctor appointments. Maybe 6% to 8% of gross income possibly reduced slightly for lower incomes. People need to have skin in the game to help reduce costs.

What?? I am honestly curious what you consider a nuisance appointment to be. I cannot think of a single person I know who has the time or money to make an appt weeks out, pay a co-pay and miss work for made up reasons. People generally do not like going to the Dr, and will sit on things for a very long time. Do you have any evidence of this assertion?

[Iplawyer]

https://www.nytimes.com/2017/02/17/upshot/to-fund-health-plan-gop-considers-limiting-popular-tax-break.html

You didn't answer the question. Your source backs up my claim that the republicans are using this idea that they originally opposed.

Metric Mouse - once you have provided support for each statement in your completely inaccurate post - I will provide you a reference.  And you, like the lie master Trump, try to twist the article I sent.  The article makes it clear that the Republicans are salivating over huuuuge, biggest, the best Cadillac policy taxes.   But thanks for trying to pivot.  It just did not work with me.

[Metric Mouse]

https://www.nytimes.com/2017/02/17/upshot/to-fund-health-plan-gop-considers-limiting-popular-tax-break.html

You didn't answer the question. Your source backs up my claim that the republicans are using this idea that they originally opposed.

Metric Mouse - once you have provided support for each statement in your completely inaccurate post - I will provide you a reference.  And you, like the lie master Trump, try to twist the article I sent.  The article makes it clear that the Republicans are salivating over huuuuge, biggest, the best Cadillac policy taxes.   But thanks for trying to pivot.  It just did not work with me.

By pivoting you mean I am correct? Republicans and Democrats both opposed this tax, Obama pushed for it as a funding measure of the ACA, and now it is included in the current Republican bill. Having read your link, I still believe this to be accurate.

Since you claimed this was incorrect, I asked for sources that I might learn something that counters my other reading. You did not supply this, resorted to hyperbole, rant about Trump (whom was not mentioned by anyone else regarding this topic) and then refused to offer sources for your claims until I please you.

Who really sounds more like DJT? :)

[sol]

Who really sounds more like DJT? :)

I am amused that the two of you, like the rest of America, are arguing over who sounds more like Trump.

"You're Hitler!"  "No, You're Hitler!"

[Metric Mouse]

Who really sounds more like DJT? :)

I am amused that the two of you, like the rest of America, are arguing over who sounds more like Trump.

"You're Hitler!"  "No, You're Hitler!"

The only thing eveyone can agree on is they don't want to be Trump right now.

[geekette]

10,000 deductible and max OOP. Plus I get a deduction for my HSA contribution.
  I think a certain amount of deductible is desirable to eliminate nuisance doctor appointments. Maybe 6% to 8% of gross income possibly reduced slightly for lower incomes. People need to have skin in the game to help reduce costs.

What?? I am honestly curious what you consider a nuisance appointment to be. I cannot think of a single person I know who has the time or money to make an appt weeks out, pay a co-pay and miss work for made up reasons. People generally do not like going to the Dr, and will sit on things for a very long time. Do you have any evidence of this assertion?

You (and I) don't know the "right" people. I follow a lot of medical blogs, and have read some...interesting rants on those who will call for an ambulance to take them to the hospital for a pregnancy test (and other such nonsense, but that one really stuck with me).

[gerardc]

ACA doesn't really solve the problem of private insurance companies that try to avoid payments... AFAICT, companies still have that incentive to scam you.

Also the "no kicking sick people off their plans" clause is hard to enforce without the pre-existing condition ban... because insurance companies can create new "innovative" plans with lower premiums or better conditions that the healthy will hop on, then just increase the premiums on the old plans for everyone (i.e. the sick people remaining).

[DavidAnnArbor]

ACA doesn't really solve the problem of private insurance companies that try to avoid payments... AFAICT, companies still have that incentive to scam you.

Also the "no kicking sick people off their plans" clause is hard to enforce without the pre-existing condition ban... because insurance companies can create new "innovative" plans with lower premiums or better conditions that the healthy will hop on, then just increase the premiums on the old plans for everyone (i.e. the sick people remaining).

Yes this is exactly the crux of the issue. We'll end up back to the bad old days of insurance companies creating very expensive plans for pre-existing conditions or old age, and then plans for the temporarily healthy.

[Classical_Liberal]

10,000 deductible and max OOP. Plus I get a deduction for my HSA contribution.
  I think a certain amount of deductible is desirable to eliminate nuisance doctor appointments. Maybe 6% to 8% of gross income possibly reduced slightly for lower incomes. People need to have skin in the game to help reduce costs.

What?? I am honestly curious what you consider a nuisance appointment to be. I cannot think of a single person I know who has the time or money to make an appt weeks out, pay a co-pay and miss work for made up reasons. People generally do not like going to the Dr, and will sit on things for a very long time. Do you have any evidence of this assertion?

You (and I) don't know the "right" people. I follow a lot of medical blogs, and have read some...interesting rants on those who will call for an ambulance to take them to the hospital for a pregnancy test (and other such nonsense, but that one really stuck with me).

This kind of stuff happens all the time, but only with folks who have no skin in the game.  People who can go to the ER without copays.  Medicaid and/or those with no insurer at all, but who have no means to pay.  Which is why it's even more important to fix healthcare.  Everyone should have some skin in the game, even if it's only $1.

[beltim]

Given ~15% inflation in healthcare costs over the last decade or so, a current plan would be expected to cost about 4x what the same thing cost in 2007.

Just for reference. I don't know that the 15% number is exactly right but if you're upset that you're paying now than you were 10 years ago... well, you would be regardless. Prices have been rising like made for 20-25 years.

-W

The actual number, by the way, is about 3.5% inflation in health care costs annually over the last 10 years.  The highest single month had (annualized) 5.2% inflation.  Facts matter.

https://data.bls.gov/timeseries/CUUR0000SAM?output_view=pct_12mths

[Monkey Uncle]

If I read the article about the republican plan correctly, the most DW and I could get would be $8k in tax credits (probably less), which would not cover my projected $17k increase in premiums.  And the actual increase is likely to be even more than my $17k estimate because the repub plan would allow insurers to charge older folks five times as much as younger folks, rather than the current limit of 3X.  It appears that people like us, who are too old for a catastrophic plan and too young for Medicare, will be the big losers in this scheme.

Too old for a catastrophic plan? Under the ACA, yes. Under the proposed system I don't know. I've read R proposals bringing back catastrophic plans but don't think ages were mentioned.

They are certainly hung ho for high deductible plans for everyone.

A catastrophic plan might be available to us under the R proposal, but it's not something we want.  Too much risk that we'll end up paying the full out of pocket amount.  Which would make the catastrophic plan just as unaffordable (or more so) as an unsubsidized silver plan.

[radram]

Given ~15% inflation in healthcare costs over the last decade or so, a current plan would be expected to cost about 4x what the same thing cost in 2007.

Just for reference. I don't know that the 15% number is exactly right but if you're upset that you're paying now than you were 10 years ago... well, you would be regardless. Prices have been rising like made for 20-25 years.

-W

The actual number, by the way, is about 3.5% inflation in health care costs annually over the last 10 years.  The highest single month had (annualized) 5.2% inflation.  Facts matter.

https://data.bls.gov/timeseries/CUUR0000SAM?output_view=pct_12mths

Thank you for looking that up. Note that while much lower than many people realize, it is still much higher than inflation for the same time period(19.64%).

https://www.statbureau.org/en/united-states/inflation

What has changed a lot the past decade is who pays.
 

[Iplawyer]

https://www.nytimes.com/2017/02/17/upshot/to-fund-health-plan-gop-considers-limiting-popular-tax-break.html

You didn't answer the question. Your source backs up my claim that the republicans are using this idea that they originally opposed.

Metric Mouse - once you have provided support for each statement in your completely inaccurate post - I will provide you a reference.  And you, like the lie master Trump, try to twist the article I sent.  The article makes it clear that the Republicans are salivating over huuuuge, biggest, the best Cadillac policy taxes.   But thanks for trying to pivot.  It just did not work with me.

By pivoting you mean I am correct? Republicans and Democrats both opposed this tax, Obama pushed for it as a funding measure of the ACA, and now it is included in the current Republican bill. Having read your link, I still believe this to be accurate.

Since you claimed this was incorrect, I asked for sources that I might learn something that counters my other reading. You did not supply this, resorted to hyperbole, rant about Trump (whom was not mentioned by anyone else regarding this topic) and then refused to offer sources for your claims until I please you.

Who really sounds more like DJT? :)

Quote from: Metric Mouse on February 26, 2017, 12:04:11 PM
Quote from: Iplawyer on February 26, 2017, 11:25:19 AM
You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.
Can you point to few sources that shows that Republicans pushed for the excise tax provison and not Obama? I have not come across this in any reading.

The excise tax was not the only source, and of course not the largest source, of funding for ACA.  Just the one of the least popular.

Quote

Quote from: Metric Mouse on February 25, 2017, 12:47:24 PM
It may depend upon the formula used to calculate the price of your insurance. I don't think that it matters how much you oay, as much as it matters how much the overall premiums are.

In futher research: the Cadillac Tax was originally opposed by republicans because it was indexed to inflation. As premiums rise much, much faster than inflation under the ACA, a larger and larger percentage of Americans would fall under this tax as time went on. Originally Republicans opposed this as they felt middle class Americans should not be subject to this tax. Democrats opposed it because their corporate and union lobby interests opposed it. Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it. Without this the ACA would not be solvent.  So now the answer to a broken Democrat plan based on a Republican plan seems to be an Obama tax that no one wanted to begin with.

So that's where this sits. Obviously the Republican replacement plan is in its infancy and will likely change much as ut moves through the committees, but that is the direction it is heading currently.
You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.

Metric Mouse - to quote one of your lies directly "Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it."  And you went on to lie again " Without this the ACA would not be solvent." Please, please, please - after spouting these outright lies - go do your own research on the truth.  And all of the replacement plans from each of the Republican factions plan to do more of the same or go further.  If you are interested in reading about the truth of the issue - this story talks about why the Republicans want it now even more so:
https://www.nytimes.com/2017/02/17/upshot/to-fund-health-plan-gop-considers-limiting-popular-tax-break.html

You do.  You post an outright lie.  You read an article that says every Republican faction is going to push the Cadillac tax harder than it is implemented now in the ACA and that does not say anything at all about Obama's stand on it one way or the other - but proclaim it supports your ridiculous lie anyway.  Then you insult me out of context without including the outright lies you made.  That, in a nutshell, is exactly like DJT.

You started this with these ridiculous lies (and I am going to repeat them here so as to keep focus on them and keep in context the nature of the conversation - something you refuse to do):

"In futher research: the Cadillac Tax was originally opposed by republicans because it was indexed to inflation. As premiums rise much, much faster than inflation under the ACA, a larger and larger percentage of Americans would fall under this tax as time went on. Originally Republicans opposed this as they felt middle class Americans should not be subject to this tax. Democrats opposed it because their corporate and union lobby interests opposed it. Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it. Without this the ACA would not be solvent.  So now the answer to a broken Democrat plan based on a Republican plan seems to be an Obama tax that no one wanted to begin with. "

You said you "researched" said lies.  Provide us your research for the absolutely unsupportable statement that "Obama pushed for it as the best single way to fund the ACA."  It is a lie on so many fronts as I already pointed out.  But you started your ridiculous post full of one lie after another with the phrase "In further research."  Show us your "research."  I'm of the opinion you don't have any.  You just pulled it out of your A** because you don't like Obama or the ACA and posted it.  I called you on it.  You tried to pivot.  But it isn't working.

[The Happy Philosopher]

https://www.theatlantic.com/politics/archive/2017/02/the-5-biggest-hurdles-for-republicans-replacing-obamacare/517728/?utm_source=atltw

What a mess this is going to be...

[jim555]

Trending:
Obamacare: Last Week Tonight with John Oliver (HBO)
https://www.youtube.com/watch?v=YEGpriv2TAc

[stoaX]

It may depend upon the formula used to calculate the price of your insurance. I don't think that it matters how much you oay, as much as it matters how much the overall premiums are.

In futher research: the Cadillac Tax was originally opposed by republicans because it was indexed to inflation. As premiums rise much, much faster than inflation under the ACA, a larger and larger percentage of Americans would fall under this tax as time went on. Originally Republicans opposed this as they felt middle class Americans should not be subject to this tax. Democrats opposed it because their corporate and union lobby interests opposed it. Obama pushed for it as the best single way to fund the ACA - force everyone to have health insurance, and mthen tax them on it. Without this the ACA would not be solvent.  So now the answer to a broken Democrat plan based on a Republican plan seems to be an Obama tax that no one wanted to begin with.

So that's where this sits. Obviously the Republican replacement plan is in its infancy and will likely change much as ut moves through the committees, but that is the direction it is heading currently.

You don't have a clue what you are talking about.  What funds the ACA is the 1% tax on income over a certain amount, the Medicare tax on capital gains over a certain amount, and other taxes on things like medical equipment.  The tax on less than 10 percent of the insurance policies sold is minuscule compared to that. The republicans wanted the Cadillac insurance plan tax.

What about the health insurer fee, PCORI and the reinsurance fee?  They added a few points to employer sponsored health insurance plans and raised billions of dollars. 

Regarding the excise tax (aka "Cadillac" tax that has been deferred and not implemented), I don't think it has as much of an effect on highly compensated employees since they are more likely to have tax favorable health insurance plans like those with health savings accounts.  At least those are the plans I see for executives when I underwrite them.  The minimum individual deductible for that kind of plan is $1300, which if far from being a cadillac plan.

[stoaX]

Given ~15% inflation in healthcare costs over the last decade or so, a current plan would be expected to cost about 4x what the same thing cost in 2007.

Just for reference. I don't know that the 15% number is exactly right but if you're upset that you're paying now than you were 10 years ago... well, you would be regardless. Prices have been rising like made for 20-25 years.

-W

The actual number, by the way, is about 3.5% inflation in health care costs annually over the last 10 years.  The highest single month had (annualized) 5.2% inflation.  Facts matter.

https://data.bls.gov/timeseries/CUUR0000SAM?output_view=pct_12mths

Thank you for looking that up. Note that while much lower than many people realize, it is still much higher than inflation for the same time period(19.64%).

https://www.statbureau.org/en/united-states/inflation

What has changed a lot the past decade is who pays.

Another link supporting what is said above:  http://www.insurancejournal.com/news/national/2015/11/12/388800.htm

And the bolded text above is spot on.

[nereo]

the unanswered question here is whether the ACA increased, decreased, or had no appreciable effect on health care increases.

[radram]

the unanswered question here is whether the ACA increased, decreased, or had no appreciable effect on health care increases.

Also a great point.

[sol]

Be careful, folks.  Some of you are talking about the rate of price inflation of health care as if it were the same thing as the rate of price inflation of health insurance.

Not the same thing.  The difference shows up as profits for insurance companies, which have been growing at an incredible rate.

[nereo]

Be careful, folks.  Some of you are talking about the rate of price inflation of health care as if it were the same thing as the rate of price inflation of health insurance.

Not the same thing.  The difference shows up as profits for insurance companies, which have been growing at an incredible rate.

Good point.  Several times throughout this thread (and all the time in various media) people confound health insurance with health care.  Indeed they are NOT the same thing.

[waltworks]

Even at an average 4%, we'd expect healthcare costs to *double every 17 years or so*. My point is that saying "it got so expensive!" is absolutely true, but that was the trend before the ACA as well.

Thanks for the data, though. I thought increases were running double digits, clearly that's not right. Still outpacing inflation by nearly double means problems in the long run... and we're at the long run now, I think.

-W

[jim555]

Today Trump says 'Nobody knew health care could be so complicated'.  Hahahaa.
Everyone knows that - everyone but him. 

Congratulations America, you hired a useless moron.

[sol]

Today Trump says 'Nobody knew health care could be so complicated'.  Hahahaa.
Everyone knows that - everyone but him. 

Congratulations America, you hired a useless moron.

I had the same initial thought, but now I think that was the point.  Some Americans voted for trump precisely because he was so unqualified.  He literally campaigned on having no relevant experience.  They wanted an outsider with no experience, and they got one.  Now they have an unqualified leader who doesn't know what he is doing, just like they asked for, so they shouldn't be surprised that he is struggling in the position.

OF COURSE he is struggling in the job.  Wasn't that the point?  Anybody who wanted a thoughtful and experienced career politician with a plethora of policy experience voted for Clinton.

[nereo]

Today Trump says 'Nobody knew health care could be so complicated'.  Hahahaa.
Everyone knows that - everyone but him. 

Congratulations America, you hired a useless moron.

I had the same initial thought, but now I think that was the point.  Some Americans voted for trump precisely because he was so unqualified.  He literally campaigned on having no relevant experience.  They wanted an outsider with no experience, and they got one.  Now they have an unqualified leader who doesn't know what he is doing, just like they asked for, so they shouldn't be surprised that he is struggling in the position.

OF COURSE he is struggling in the job.  Wasn't that the point?  Anybody who wanted a thoughtful and experienced career politician with a plethora of policy experience voted for Clinton.

Video of Trump saying "Nobody knew healthcare could be so complicated"
https://www.theguardian.com/us-news/video/2017/feb/27/trump-healthcare-complicated-budget-video

Trump was elected in large part because he had no political experience.  Then he filled many of his posts with individuals who have no experience doing the jobs they have been appointed to do - the common thread seems to be they are all rich, and to some (certainly to DJT) being rich means you should be successful anywhere.  DeVos, McMahon, & Carson lead the pack with positions they have no experience with AND no real political skills. Tillerson isn't far behind those three.  Others (Haley, Perry) have political experience but little experience in their new roles. Then there's people like Pruit and (again) Perry who have been openly hostile to the departments they are now running.  Actually, count Bannon in that last column too.

If you wanted to maximize conflicts, scandals and inefficiency, this wouldn't be a bad strategy.  Hell, maybe it IS the strategy; make them all dis-functional to the point where people don't mind that their funding gets repeatedly hacked apart.

Interestingly, the National Security advisor went to a Lt. General (McMaster) - someone with both experience in military doctrine and military politics. 

[sol]

Interestingly, the National Security advisor went to a Lt. General (McMaster) - someone with both experience in military doctrine and military politics.

Even a stopped clock...

[nereo]

Interestingly, the National Security advisor went to a Lt. General (McMaster) - someone with both experience in military doctrine and military politics.

Even a stopped clock...

I was thinking more along the lines of: The things that matter to you are the ones you allow to succeed.
...or something.

where are we going for Trump War®?

[Cassie]

Most countries have a single payor that is not costing everyone a small fortune. My DIL is from Poland and does most of her healthcare there when she visits. My son is not on it but he paid cash for a shot that cost him 100 instead of the 1k in the states.

[nereo]

Most countries have a single payor that is not costing everyone a small fortune. My DIL is from Poland and does most of her healthcare there when she visits. My son is not on it but he paid cash for a shot that cost him 100 instead of the 1k in the states.

Most...? no.  Most people...? also no.
Of the ten largest countries (by population), only Japan has a single-payer system, and it's #10 populaiton wise with just over 1/3 as many people as the US.

The US does run away with the title of "most expensive health care system (per capita)" - but that doesn't mean that single-payer systems always win.
 Norway (single payer) spends far more than Chile (not single-payer). The UK is about 4x over Mexico.  Some countries have a two-tier system like Australia, which spends about as much as single-payer Canada. Thailand has some excellent hospitals with some of the lowest out-of-pocket costs for in-patient procedures, yet not national healthcare system to speak of.

tl/dr: cost of health care is not tightly correlated to whether that country is a single-payer system.

[Paul der Krake]

Most countries have a single payor that is not costing everyone a small fortune. My DIL is from Poland and does most of her healthcare there when she visits. My son is not on it but he paid cash for a shot that cost him 100 instead of the 1k in the states.

Most...? no.  Most people...? also no.
Of the ten largest countries (by population), only Japan has a single-payer system, and it's #10 populaiton wise with just over 1/3 as many people as the US.

The US does run away with the title of "most expensive health care system (per capita)" - but that doesn't mean that single-payer systems always win.


 Norway (single payer) spends far more than Chile (not single-payer). The UK is about 4x over Mexico.  Some countries have a two-tier system like Australia, which spends about as much as single-payer Canada. Thailand has some excellent hospitals with some of the lowest out-of-pocket costs for in-patient procedures, yet not national healthcare system to speak of.

tl/dr: cost of health care is not tightly correlated to whether that country is a single-payer system.

It's silly to compare countries with completely different cultures and standards of living. Japan, Canada, Germany, the UK are fine to use for comparison.

China, Chile, Thailand, are not. Even some countries in the G20 are a bit of a stretch.

[nereo]

Most countries have a single payor that is not costing everyone a small fortune. My DIL is from Poland and does most of her healthcare there when she visits. My son is not on it but he paid cash for a shot that cost him 100 instead of the 1k in the states.

Most...? no.  Most people...? also no.
Of the ten largest countries (by population), only Japan has a single-payer system, and it's #10 populaiton wise with just over 1/3 as many people as the US.

The US does run away with the title of "most expensive health care system (per capita)" - but that doesn't mean that single-payer systems always win.


 Norway (single payer) spends far more than Chile (not single-payer). The UK is about 4x over Mexico.  Some countries have a two-tier system like Australia, which spends about as much as single-payer Canada. Thailand has some excellent hospitals with some of the lowest out-of-pocket costs for in-patient procedures, yet not national healthcare system to speak of.

tl/dr: cost of health care is not tightly correlated to whether that country is a single-payer system.

It's silly to compare countries with completely different cultures and standards of living. Japan, Canada, Germany, the UK are fine to use for comparison.

China, Chile, Thailand, are not. Even some countries in the G20 are a bit of a stretch.

That's kinda my point, Paul.  Comparing the US to Poland (as the OP did) and suggesting that a single-payer system is the reason health care is so expensive in the US is a huge stretch. There is also no country with a single-payer system that's a truly good comparison to the US.

[beltim]

Be careful, folks.  Some of you are talking about the rate of price inflation of health care as if it were the same thing as the rate of price inflation of health insurance.

Not the same thing.  The difference shows up as profits for insurance companies, which have been growing at an incredible rate.

I agree that those are not the same thing.  I do not agree that the difference is profit for insurance companies.  It could be, but it could also be a change in percentage of expenses covered by insurance, or costs of providing insurance.  And either of those, plus profits, could be either positive or negative.  You'll need to provide a citation that shows any evidence that the profits for health insurance companies have been growing at an incredible rate.

[obstinate]

Be careful, folks.  Some of you are talking about the rate of price inflation of health care as if it were the same thing as the rate of price inflation of health insurance.

Not the same thing.  The difference shows up as profits for insurance companies, which have been growing at an incredible rate.

I agree that those are not the same thing.  I do not agree that the difference is profit for insurance companies.  It could be, but it could also be a change in percentage of expenses covered by insurance, or costs of providing insurance.  And either of those, plus profits, could be either positive or negative.  You'll need to provide a citation that shows any evidence that the profits for health insurance companies have been growing at an incredible rate.

As of 2014, underwriting gain (== profit) was down significantly. I don't know where it's at now.

[fasteddie911]

Be careful, folks.  Some of you are talking about the rate of price inflation of health care as if it were the same thing as the rate of price inflation of health insurance.

Not the same thing.  The difference shows up as profits for insurance companies, which have been growing at an incredible rate.

I agree that those are not the same thing.  I do not agree that the difference is profit for insurance companies.  It could be, but it could also be a change in percentage of expenses covered by insurance, or costs of providing insurance.  And either of those, plus profits, could be either positive or negative.  You'll need to provide a citation that shows any evidence that the profits for health insurance companies have been growing at an incredible rate.

Agree with both of you, sort of.  Reimbursements have barely budged over the years while premiums continue to increase.  While I'm not sure about insurance company profits, seemingly hospitals, ER's, offices, etc. are as busy as ever, patients are sicker with a greater range of issues and complexities, and medical technology and knowledge (thus, the ability to keep people alive longer and spend money to do so) are probably at the greatest it has ever been. 

[jim555]

If Obamacare Exits, Some May Need to Rethink Early Retirement
https://www.nytimes.com/2017/02/27/upshot/if-obamacare-exits-some-may-need-to-rethink-early-retirement.html

[AdrianC]

Could normal people retire before the ACA? I seem to remember that they did, but I may be mis remebering.

Not only retire, some people started businesses and became self-employed. But that was back when the individual insurance market was stable. It's a bit unsettling right now.

[semiretired31]

Not a terribly optimistic outlook.  But, made me chuckle none the less...  John Oliver on the coming GOP plan. 

https://www.youtube.com/watch?v=YEGpriv2TAc

[Mr Mark]

'so complicated'  - I had to LMAO at that one.

http://edition.cnn.com/2017/02/27/politics/mark-meadows-vote-leaked-obamacare-bill/

Right wing GOP not liking the fudges proposed on tax credits:

Meadows told CNN that what is unacceptable to him are the refundable tax credits included in the draft of the bill. Those tax credits, the North Carolina congressman said, are nothing short of an "entitlement program."

"What is conservative about a new entitlement program and a new tax increase? And should that be the first thing that the President signs of significance that we sent to the new President?" Meadows said in an interview. "A new Republican president signs a new entitlement and a new tax increase as his first major piece of legislation? I don't know how you support that -- do you?"

The congressman also took issue with the way the tax credits would be given out, arguing that it would make some wealthy individuals eligible.

"So the headline is that the GOP is reducing subsidies to needy individuals when in fact, the growth of the taxpayer-subsidized reimbursements will actually increase. The total dollars that we spend on subsidies will be far greater," he said. "So you can be a millionaire and not have employer-based health care and you're going to get a check from the federal government -- I've got a problem with that."

(my emphasis)

I presume however that they are not talking millionaire assets/NW but 'income'? Are there any means tested benefits in USA currently that test on wealth rather than income?

[Paul der Krake]

I presume however that they are not talking millionaire assets/NW but 'income'? Are there any means tested benefits in USA currently that test on wealth rather than income?

SNAP has a resources test:

https://www.fns.usda.gov/snap/fact-sheet-resources-income-and-benefits

However states have some leeway as to what they enforce.

http://www.governing.com/topics/health-human-services/gov-states-rethink-asset-test-people-food-stamps.html

Basically it's a huge hassle to enforce.

[jim555]

In my state no resource test for SNAP, only income.  But it only lasts for 3 months (unless unemployment is very high).  Big pain for not much.

[protostache]

I presume however that they are not talking millionaire assets/NW but 'income'? Are there any means tested benefits in USA currently that test on wealth rather than income?

Traditional disability Medicaid is means tested. Typically you can only have a very limited amount of assets other than your primary house and a single car. If you have to move out of your house into a nursing home or when you die, Medicaid recovers their costs from your estate.

[LibrarianFuzz]

I read the "If Obamacare Exits..." article too. It really underscores the role of health in the decision for early retirement.

"But that study also found that workers in poor health who had retiree health benefits were 88 percent more likely to retire early compared with similar workers lacking retiree health benefits."

[jim555]

Trump's bigly announcement tonight. 
The house going over the ACA changes today...

[Roland of Gilead]

Pre ACA people still early retired, they just gambled more with their healthcare.

Every year fewer and fewer people are eligible for retiree healthcare from work.  Some public employees still get it but not many private employees.

Anyway, if they screw all of this up, the earliest it will take effect is 2018 and then we get a democrat in 2020 and get ACA back again by 2021.

[fuzzy math]

You (and I) don't know the "right" people. I follow a lot of medical blogs, and have read some...interesting rants on those who will call for an ambulance to take them to the hospital for a pregnancy test (and other such nonsense, but that one really stuck with me).

True, I did discount this segment of the population. But this is the segment who will never change their behaviors even if they "have skin in the game" like the previous poster was alluding to.
These people probably have Medicaid, or are uninsured. Cutting their insurance is not going to make them suddenly less dumb or mentally ill, won't make them more employable, and they're still going to be seeking out the ER for their care, except now the hospital is going to have to write it off (if they aren't already).

[jim555]

Those without insurance and too poor to afford medical bills go to the ER because the hospital has to look at them by law.  So it is not irrational it actually is a reasonable action in that situation.

[redpillgreen]

What comes after ACA?

Fire and brimstone. Locusts.

[Mr Mark]

I presume however that they are not talking millionaire assets/NW but 'income'? Are there any means tested benefits in USA currently that test on wealth rather than income?

Traditional disability Medicaid is means tested. Typically you can only have a very limited amount of assets other than your primary house and a single car. If you have to move out of your house into a nursing home or when you die, Medicaid recovers their costs from your estate.

As is long term nursing home care. Generally have to spend down all your assets before you can qualify.  They will also recover any costs you incur once age 55 or older from your estate.

I'm not sure what other programs here in Cali are means tested but Im sure there are some. Also before March 2014 the VA did means testing along with income and used NW to determine your eligibility and costs to use VA healthcare for anything besides a service-connected injury or disability. Now they just use income testing so that they are inlinevwith the ACA. I imagine it will go back to means testing (and they want you to list everything like art work, jewelry, etc...) once/if the ACA is abolished.

Got ya.

Hence the (mis-)use of 529s and trusts to stash funds into and move them off the balance sheet?

[Mr Mark]

Those without insurance and too poor to afford medical bills go to the ER because the hospital has to look at them by law.  So it is not irrational it actually is a reasonable action in that situation.

Exactly. There are a lot of people on medicare/medicaid with zero money/assets. They need some kind of treatment but don't have a car or even money for a taxi or uber. Or they have a disability. As the system won't reimburse a taxi they call for an ambulance at like $800 a ride.

This is an example of the problem with a health system that disconnects community care and preventative care aspects from medical treatment. Even a single payer system doesn't necessarily fix that. EG The UK (with an almost fully nationalised health system) has been seeing issues where local Gov transfers people needing care (which would be paid locally) to a much more costly bed at an NHS hospital (paid nationally).

[gerardc]

In Canada (Quebec) ambulance is free for those on social-welfare. Health care is free for all residents. I've heard of people calling an ambulance in order to get home, as they lived close to a hospital. They even tried to carry on grocery bags in the ambulance...