Author Topic: What comes after the ACA?  (Read 1138862 times)

SugarMountain

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Re: What comes after the ACA?
« Reply #5500 on: May 08, 2019, 02:35:45 PM »
"The court filing, while expected since late March, signaled a no-holds-barred effort by the Justice Department to wipe out a law that has extended health insurance to 20 million Americans."

If someone made a half-hearted effort, they could organize these folks.  This health care thing can mean a lot of votes.
You're joking right? This is one of the least politically-involved demographic, largely poor and hidden away. They polled the people who were going to benefit from it in 2014 when the law was coming into effect after YEARS of public discourse, and the majority couldn't tell you what the law did and for whom.

Right.  There is a huge portion of the population who doesn't know that Obamacare and the Affordable Care Act are the same thing.  Unsurprisingly, the ACA polls much better than "Obamacare" and the individual parts of the ACA poll even better.  A recent facepalm came from right wing something (not sure what she is, blogger, tweeter, provocateur, or just idiot) Tomi Lahren.  She was asked about whether she was on Obamacare and she said something like, "oh no, I'm on my parents' policy"....which is only possible because Obamacare raised the age of that to 26.

https://thehill.com/blogs/blog-briefing-room/news/344507-obamacare-opponent-im-still-on-my-parents-insurance

Exflyboy

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Re: What comes after the ACA?
« Reply #5501 on: May 08, 2019, 02:40:53 PM »

Seems to me the Republican base is more motivated around dogma. This is rational.. Yes jobs HAVE been shipped overseas, yes there has been a war on coal (and the miners).

And yet automation is the main reason why most of these jobs are gone.

With mountain top removal for coal mining, it only takes a handful of jobs what used to be hundreds to dig underground tunnels for mining.

In West Virginia there are about 10 times as many jobs in health care as compared to coal miners. And the ACA provided support for the health care industry in West Virginia by expanding Medicaid.

Agreed! But when your one of the hundreds of coal miners that has lot their job (and your pension when the company executives slipped out the back door clutching gold bars), anyone that shows up and promises your job back then your going to vote for them.

Once again .. Getting your job back, America first is a simple message.

Arguing about the real cause of your job loss in the first place is complex and kinda irrelevant as you meet your fellow unemployed buddies at the black lung clinic.

DaMa

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Re: What comes after the ACA?
« Reply #5502 on: May 08, 2019, 04:04:25 PM »
Here's how I would build that:

I am a small business owner. The ACA forced me to lay off three staff to get below the fifty-employee threshold because I couldn't afford to offer benefits in-house. Because I live in a small area, I happened to be in contact with one of those three--who opted to pay the penalty and not sign up for an ACA-compliant plan--and she died from a condition that would have been easily treated. Under business-as-usual, she could have gotten a plan she needed to keep her alive.

For some reason, I haven't heard any stories like this????

Maybe because if the 53 person company couldn't buy their employees insurance after ACA, they probably weren't buying it before the ACA came along, so this person didn't have any health insurance previously?  And if they were laid off and weren't able to find another job, they were most likely medicaid eligible, especially in states that expanded medicaid?  Or maybe the person had a pre-existing condition and would have been uninsurable at any price prior to ACA (in which case choosing to forgo coverage and pay the penalty was a bad decision).

Or maybe it's because you would have only made 200k a year instead of 800k by providing health coverage to your employees.
Or maybe that person didn't buy an ACA plan because she spent that 1k per month on cigarettes, cable, iPhone, new cars, etc.
My point is there is always more to the story. 

Here's the flip side.  My DH and DS would be better on ACA (coverage and cost) if their employer would drop coverage, because their income is low enough to qualify for subsidies. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5503 on: May 08, 2019, 04:26:28 PM »
You should all be aware that the Democrats passed a bill in the House to expand the subsidies of the ACA, to make the cliff less severe, to opt for ACA if employer coverage is so poor that it would be a better option for marketplace coverage etc.

I know McConnell won't take up the bill, nor would Trump sign it, though it would greatly alleviate financial burdens for millions of the working class.

katsiki

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Re: What comes after the ACA?
« Reply #5504 on: May 09, 2019, 08:44:19 AM »
Right.  There is a huge portion of the population who doesn't know that Obamacare and the Affordable Care Act are the same thing.

This blows my mind!

Wow.

SugarMountain

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Re: What comes after the ACA?
« Reply #5505 on: May 09, 2019, 03:26:18 PM »
Right.  There is a huge portion of the population who doesn't know that Obamacare and the Affordable Care Act are the same thing.

This blows my mind!

Wow.

https://www.nytimes.com/2017/02/07/upshot/one-third-dont-know-obamacare-and-affordable-care-act-are-the-same.html

sol

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Re: What comes after the ACA?
« Reply #5506 on: May 19, 2019, 11:01:56 PM »
Washington State just passed a public option.  A state-sponsored, public health care option available on the state's ACA exchange, available in every county in the state to every state resident.  It's the first in the nation.

It's not a perfect solution, by any means, but I think it's a step in the right direction.  The original plan was to offer providers the medicare reimbursement rates, and encourage compliance by denying them access to state's public employee health plans if they chose not to participate.  But they caved in the end and raised the reimbursement rate to 160% of the medicare rate, which guarantees widespread adoption but does much less to control costs.  It's only expected to be 5 to 10% cheaper than the existing private plans on the exchange.

The plan also doesn't modify the existing ACA subsidy structure (though WA has already expanded medicaid) and it doesn't (and probably can't) address drug pricing at the state level.  So like I said, not perfect but still a step in the right direction.  The primary benefit is expected to be to people in rural counties who currently only have one or two insurers operating in their county on the state exchange.  People in King County already have all kinds of health insurance options and good competition between them so they're fine, but the public option should notably lower costs for people in more rural areas.

« Last Edit: May 19, 2019, 11:04:41 PM by sol »

freya

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Re: What comes after the ACA?
« Reply #5507 on: May 20, 2019, 06:40:11 AM »
We'll have to see how this works, but getting a foot in the door for public options is a good thing.  Wish they'd also done something about prescription drug prices.  An easy solution would be to align reimbursement to drug companies to Canada's negotiated rates.

They're not quite trailblazing though.  New York's Obamacare plans are similar to a public option:  they are all effectively Medicaid managed care plans, just with a premium for anyone not qualifying for Medicaid.  Which is a low bar, given that 1/3 of the state's population is on Medicaid.  The major private insurers (United, Aetna) have no Obamacare options and are pretty much off limits to anyone not working for a large employer or wealthy enough to fork over $20K/year for an individual policy.

These plans are widely accepted because of the large number of subscribers - I guess all in all about half the state's population, between Medicaid and those who buy into Obamacare.  In fact, hospitals are making an effort to attract these patients, so they're not limited to public hospitals like Bellevue, and there's no obvious two-tiered service structure.   Presumably that's the path that Washington will have to follow, if this is going to succeed.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5508 on: May 20, 2019, 09:36:55 AM »
Washington State just passed a public option.  A state-sponsored, public health care option available on the state's ACA exchange, available in every county in the state to every state resident.  It's the first in the nation.

It's not a perfect solution, by any means, but I think it's a step in the right direction.  The original plan was to offer providers the medicare reimbursement rates, and encourage compliance by denying them access to state's public employee health plans if they chose not to participate.  But they caved in the end and raised the reimbursement rate to 160% of the medicare rate, which guarantees widespread adoption but does much less to control costs.  It's only expected to be 5 to 10% cheaper than the existing private plans on the exchange.
The mechanics of it are very interesting, especially the part about the reimbursement rates.  The fact that it will pay 160% of medicare rates raises some interesting questions:

1) was the far-lower reimbursement rate expected to cause a severe shortage of providers?  Using a state monopoly to "encourage" (wow, how Orwellian) compliance would seem to strongly support that supposition.
2) in general, for those providers who *do* accept Medicare, does that mean that Medicare patients are subsidized twice, once by taxes and once by those who are paying higher rates?

seattlecyclone

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Re: What comes after the ACA?
« Reply #5509 on: May 20, 2019, 11:47:41 AM »
1) was the far-lower reimbursement rate expected to cause a severe shortage of providers?

Seems like a reasonable assumption. Medicare and Medicaid pay less than private insurers, but they provide a high enough volume of patients that many providers have a hard time turning them away. This public option that covers only a fraction of the under-65s is much easier to reject in hopes that you'll get enough patients with private coverage.

Quote
2) in general, for those providers who *do* accept Medicare, does that mean that Medicare patients are subsidized twice, once by taxes and once by those who are paying higher rates?

Yes, a little bit. Here's an article quoting MedPAC statistics that even the most efficient tier of hospitals tend to lose 2% on Medicare patients. Less-efficient hospitals presumably lose a bit more.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5510 on: May 20, 2019, 11:51:47 AM »
How did they settle on 160%?

seattlecyclone

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Re: What comes after the ACA?
« Reply #5511 on: May 20, 2019, 11:59:26 AM »
How did they settle on 160%?

This article discusses that a bit. Apparently 100% of Medicare reimbursement would have meant a 40% cost reduction over private plans, but there was concern that few providers would sign on. The 160% reimbursement figure means a 5-10% cost reduction, with less risk of the network being too small. I guess they'll see how it goes and maybe try to tweak it downward a bit in the future if they think they can get away with it.

Exflyboy

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Re: What comes after the ACA?
« Reply #5512 on: May 20, 2019, 12:28:36 PM »
So do recipients of these new State plans also qualify for subsidies like they do on the ACA plans?

The subsidies come from the FEDs so is seems like that might lead to the subsidies being cut off perhaps?

seattlecyclone

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Re: What comes after the ACA?
« Reply #5513 on: May 20, 2019, 12:41:35 PM »
I believe the goal for the Washington plan is to comply with all the regulations necessary to sell the public plan on the state's ACA exchange alongside the private plans, subsidies and all.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5514 on: May 20, 2019, 02:16:55 PM »
This is encouraging. I like the idea of pegging it to Medicare prices. Cost control is the only way this is going to work.

Exflyboy

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Re: What comes after the ACA?
« Reply #5515 on: May 20, 2019, 03:00:42 PM »
Cool no doubt we'll be watching how it goes from down here in Oregon.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5516 on: May 23, 2019, 05:25:52 PM »
https://khn.org/news/sen-alexander-releases-bipartisan-plan-to-lower-health-costs-end-surprise-bills/

There appears to be real momentum behind this. Good news for traveling early retirees.

rantk81

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Re: What comes after the ACA?
« Reply #5517 on: May 23, 2019, 05:29:04 PM »
oh that would be wonderful... to be able to go to a facility listed as "in-network" -- and then be guaranteed, by law, that all services/providers at that location are to be billed as in-network!

Aggie1999

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Re: What comes after the ACA?
« Reply #5518 on: May 23, 2019, 05:52:58 PM »
https://khn.org/news/sen-alexander-releases-bipartisan-plan-to-lower-health-costs-end-surprise-bills/

There appears to be real momentum behind this. Good news for traveling early retirees.

Would certainly be awesome:

Quote
The novel part from Alexander and Murray is the idea of an “in-network guarantee.” It requires that any hospital considered “in-network” for a health plan must promise that everyone working there is also in-network.

This would avoid situations in which patients choose a hospital because they know their insurance company will cover the bill, only to find out that one of the doctors they saw was out-of-network, leaving the patient with a hefty bill.

It also requires that labs and diagnostic tests be in-network, cutting off another avenue of surprise bills.

Threshkin

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Re: What comes after the ACA?
« Reply #5519 on: June 03, 2019, 07:13:00 PM »
Washington State just passed a public option.  A state-sponsored, public health care option available on the state's ACA exchange, available in every county in the state to every state resident.  It's the first in the nation.

It's not a perfect solution, by any means, but I think it's a step in the right direction.  The original plan was to offer providers the medicare reimbursement rates, and encourage compliance by denying them access to state's public employee health plans if they chose not to participate.  But they caved in the end and raised the reimbursement rate to 160% of the medicare rate, which guarantees widespread adoption but does much less to control costs.  It's only expected to be 5 to 10% cheaper than the existing private plans on the exchange.

The plan also doesn't modify the existing ACA subsidy structure (though WA has already expanded medicaid) and it doesn't (and probably can't) address drug pricing at the state level.  So like I said, not perfect but still a step in the right direction.  The primary benefit is expected to be to people in rural counties who currently only have one or two insurers operating in their county on the state exchange.  People in King County already have all kinds of health insurance options and good competition between them so they're fine, but the public option should notably lower costs for people in more rural areas.

@sol
This is very interesting.  I love the concept, it potentially creates a very large insured group that should help manage the overall cost structure.  Big groups are critical for controlling and estimating insurances expenses.  Is there any information on the budget impact to the state?

Exflyboy

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Re: What comes after the ACA?
« Reply #5520 on: June 03, 2019, 10:00:38 PM »
oh that would be wonderful... to be able to go to a facility listed as "in-network" -- and then be guaranteed, by law, that all services/providers at that location are to be billed as in-network!

We actually have that now in Oregon. The problem is you go more than 5 miles away from home and suddenly nothing is in-Network.

ysette9

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Re: What comes after the ACA?
« Reply #5521 on: June 03, 2019, 10:27:55 PM »
oh that would be wonderful... to be able to go to a facility listed as "in-network" -- and then be guaranteed, by law, that all services/providers at that location are to be billed as in-network!

We actually have that now in Oregon. The problem is you go more than 5 miles away from home and suddenly nothing is in-Network.
That is how Kaiser works in California. Everything is in the system so everything is in network. No surprise bills. No questioning what your coverage is.

sol

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Re: What comes after the ACA?
« Reply #5522 on: June 03, 2019, 11:16:29 PM »
@sol
Is there any information on the budget impact to the state?

Not that I know of, but I haven't really been following along with the news recently.  Been busy out in the real world.  Retirement is exhausting.

rantk81

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Re: What comes after the ACA?
« Reply #5523 on: June 04, 2019, 06:03:37 AM »
oh that would be wonderful... to be able to go to a facility listed as "in-network" -- and then be guaranteed, by law, that all services/providers at that location are to be billed as in-network!

We actually have that now in Oregon. The problem is you go more than 5 miles away from home and suddenly nothing is in-Network.

Ahh  So there's a catch.  Still it would be great peace-of-mind to know you could go somewhere without risk of nearly unlimited financial exposure.

I'm actually familiar with that "small network" stuff.  My employer's sponsored plan last year was a very narrow network which only had in-network providers in my hometown.  After I signed up for the plan, I sent my boss (and boss's boss) an email saying that due to the financial risk of ever needing any kind of medical care outside of my hometown, and not having any health coverage elsewhere, I will not be available for any company related travel throughout the calendar year 2018, and until the plan was changed to a nationwide network.

This year, we have a different network -- another "small/restricted" network -- but it is at least nation-wide.  (Although, it seems that the "best" research-based facilities in most areas are not part of the network, unfortunately.)

There's always a catch....

pecunia

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Re: What comes after the ACA?
« Reply #5524 on: June 04, 2019, 08:00:40 PM »
So, like what happens if you travel North of the border, eh?

Will American health insurance reimburse the Canucks?  Will the Canadians just pick up the tab to show they are good people?

Will they just put you on a flatbed South and dump you over the line?

Will they put you on a flatbed North where you'll be the next meal for a Polar bear?

I mean, Jeepers, if the insurance becomes bogus just by traveling 5 miles to another doctor, how does this international thing work?

Maybe the American health insurance companies somehow have figured a way to bill the Canadians for the revenue they would have lost if you would have got sick in the US instead of up there.

My one suspicion is that however it works, I'll bet it is not simple.

FIREstache

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Re: What comes after the ACA?
« Reply #5525 on: June 04, 2019, 08:09:14 PM »

Look into travel insurance.  It was actually discussed earlier in this thread and in another thread in the last week.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5526 on: June 04, 2019, 08:36:51 PM »
Look into travel insurance.  It was actually discussed earlier in this thread and in another thread in the last week.

And even if you don't have travel insurance, you'll just get charged the full price in that country, which will often seem laughably low to those of us accustomed to US prices.

Exflyboy

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Re: What comes after the ACA?
« Reply #5527 on: June 05, 2019, 10:48:29 AM »
For travel insurance check out Berkshire Hathaway insurance.. The two time I have used it it was very low cost and pretty comprehensive coverage.

https://www.bhtp.com/

FIREstache

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Re: What comes after the ACA?
« Reply #5528 on: July 09, 2019, 05:24:31 PM »
I'm surprised no one has posted an update to this thread today.  The ACA hearing in the appeals court was today.

Appeals Court Seems Skeptical About Constitutionality of Obamacare Mandate


https://www.nytimes.com/2019/07/09/health/obamacare-appeals-court.html

Republican-appointed judges appear to side with Texas challenge to Obamacare

https://www.cnn.com/2019/07/09/politics/obamacare-appeal-arguments-texas-california/index.html

Appeals court skeptical Obamacare can survive

https://www.politico.com/story/2019/07/09/obamacare-lawsuit-1404171

« Last Edit: July 09, 2019, 07:17:39 PM by FIREstache »

Exflyboy

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Re: What comes after the ACA?
« Reply #5529 on: July 09, 2019, 06:45:14 PM »
But don't worry Mitch McConnell says he has a plan.

Just like last eh Mitch?

Paul der Krake

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Re: What comes after the ACA?
« Reply #5530 on: July 09, 2019, 06:51:12 PM »
If the appeals court rules in favor of Texas, the decision is pretty much guaranteed to be stayed until the Supreme Court rules on it. Which brings us to a decision next summer during what is already slated to be a crazy election year.

If the ACA is defeated again, then it won't be effective until... 2021? 2022?

If it's 2021, a new Congress wouldn't have time to undo the ACA's undoing, but if it's 2022, it could work.

Soooooo, as usual, wait and see.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5531 on: July 09, 2019, 07:04:18 PM »
"Appeals Court Seems Skeptical About Constitutionality of Obamacare Mandate"

https://www.nytimes.com/2019/07/09/health/obamacare-appeals-court.html

"If Judge O’Connor’s decision stands, the number of uninsured people in America would increase by almost 20 million, or 65 percent, according to the Urban Institute, a left-leaning research organization. That includes millions who gained coverage through the law’s expansion of Medicaid, and millions more who receive subsidized private insurance through the law’s online marketplaces."

"The Kaiser Family Foundation, a nonpartisan research organization, has estimated that 52 million adults from 18 to 64, or 27 percent of that population, would be rejected for individual market coverage under the practices that were in effect in most states before the Affordable Care Act."


https://www.kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/

Paul der Krake

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Re: What comes after the ACA?
« Reply #5532 on: July 09, 2019, 07:08:37 PM »

pecunia

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Re: What comes after the ACA?
« Reply #5533 on: July 09, 2019, 08:02:20 PM »
I guess COBRA is good for 18 months if you will FIRE soon.  It's expensive, but it's there if your employer has you covered when you quit and has 20 employees.  I don't think they will go after COBRA.  After the 18 months, something should be worked out by then.  People will be very angry if it isn't.

FIREstache

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Re: What comes after the ACA?
« Reply #5534 on: July 09, 2019, 08:24:25 PM »
I guess COBRA is good for 18 months if you will FIRE soon.  It's expensive, but it's there if your employer has you covered when you quit and has 20 employees.  I don't think they will go after COBRA.  After the 18 months, something should be worked out by then.  People will be very angry if it isn't.

COBRA could be double the cost for me, but 18 months isn't that long to have coverage, and I hate to FIRE without knowing there's going to be reliable coverage that doesn't cost me a fortune for the following 8 years.  I already had to delay FIRE an extra year because of this mess, and if it goes to SCOTUS, it looks like there may not be a final ruling until after next spring when I was hoping to FIRE.  Considering that, I might have to delay FIRE again or take a risk by jumping into the unknown.

Exflyboy

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Re: What comes after the ACA?
« Reply #5535 on: July 09, 2019, 08:48:09 PM »
Well if they can hold off for 7 years I'll be eligible for Medicare.. Then my HC costs will skyrocket!.. But not as much as if the ACA goes away.

In my case if they piss me off enough we'll simply leave the country.. I find that incredibly sad but thats the cost of FIRE I guess.

pecunia

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Re: What comes after the ACA?
« Reply #5536 on: July 10, 2019, 04:57:00 AM »
Well if they can hold off for 7 years I'll be eligible for Medicare.. Then my HC costs will skyrocket!.. But not as much as if the ACA goes away.

In my case if they piss me off enough we'll simply leave the country.. I find that incredibly sad but thats the cost of FIRE I guess.

Makes me wonder how many people the health care system have forced out of the US.  I've been hearing good things about Costa Rica lately.  It is supposed to have a good medical system.  My image of these Central American countries is that they are all poor countries picking fruit and coffee beans for huge foreign countries.   Hearing of good reasonable health care in one of those countries amazes me.

https://en.wikipedia.org/wiki/Healthcare_in_Costa_Rica

iris lily

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Re: What comes after the ACA?
« Reply #5537 on: July 10, 2019, 05:07:47 AM »
I guess COBRA is good for 18 months if you will FIRE soon.  It's expensive, but it's there if your employer has you covered when you quit and has 20 employees.  I don't think they will go after COBRA.  After the 18 months, something should be worked out by then.  People will be very angry if it isn't.

COBRA could be double the cost for me, but 18 months isn't that long to have coverage, and I hate to FIRE without knowing there's going to be reliable coverage that doesn't cost me a fortune for the following 8 years.  I already had to delay FIRE an extra year because of this mess, and if it goes to SCOTUS, it looks like there may not be a final ruling until after next spring when I was hoping to FIRE.  Considering that, I might have to delay FIRE again or take a risk by jumping into the unknown.

Oh just jump. I retired 4+ years ago and the ACA had been threatened from before then. I was DONE with work and wasnt going to let political nattering stop me. Maybe I was lucky (and well we did have a COBRA policy dor the max period) but it has been fine.

Exflyboy

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Re: What comes after the ACA?
« Reply #5538 on: July 10, 2019, 11:55:58 AM »
Well if they can hold off for 7 years I'll be eligible for Medicare.. Then my HC costs will skyrocket!.. But not as much as if the ACA goes away.

In my case if they piss me off enough we'll simply leave the country.. I find that incredibly sad but thats the cost of FIRE I guess.

Makes me wonder how many people the health care system have forced out of the US.  I've been hearing good things about Costa Rica lately.  It is supposed to have a good medical system.  My image of these Central American countries is that they are all poor countries picking fruit and coffee beans for huge foreign countries.   Hearing of good reasonable health care in one of those countries amazes me.

https://en.wikipedia.org/wiki/Healthcare_in_Costa_Rica

It depends on what you mean by being "forced" I guess..

Obviously there are a lot of older folks (62 and up) who have chosen to retire abroad due to the impending cost of Medicare.. Like when they realise its really going to hit them in the pocket.

From a FIREe perspective its a slightly different game.. In theory at least you calculate what retirement costs you before you bail out of work. For 9 years we've had the ACA so its been easy to project HC costs and to keep those costs low with subsidies. Moving abroad because you're forced to is a non issue (in theory) so there won't be many people who have.

I suspect there will be a few FIREes who will choose to emigrate if the choice is No ACA or go back to work.

Strubbelkopf

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Re: What comes after the ACA?
« Reply #5539 on: July 10, 2019, 12:03:33 PM »
Does anyone have any insight as to what would happen to the public option Sol mentioned in Washington State if the ACA were struck down?  Would that be an option less drastic than expatting?

I know some other states have also done some interesting things, like VT, NJ, MA, and DC.  I am curious to know how their initiatives would be affected by the ACA being struck down. 

ysette9

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Re: What comes after the ACA?
« Reply #5540 on: July 10, 2019, 12:53:12 PM »
Well if they can hold off for 7 years I'll be eligible for Medicare.. Then my HC costs will skyrocket!.. But not as much as if the ACA goes away.

In my case if they piss me off enough we'll simply leave the country.. I find that incredibly sad but thats the cost of FIRE I guess.

Makes me wonder how many people the health care system have forced out of the US.  I've been hearing good things about Costa Rica lately.  It is supposed to have a good medical system.  My image of these Central American countries is that they are all poor countries picking fruit and coffee beans for huge foreign countries.   Hearing of good reasonable health care in one of those countries amazes me.

https://en.wikipedia.org/wiki/Healthcare_in_Costa_Rica

It depends on what you mean by being "forced" I guess..

Obviously there are a lot of older folks (62 and up) who have chosen to retire abroad due to the impending cost of Medicare.. Like when they realise its really going to hit them in the pocket.

From a FIREe perspective its a slightly different game.. In theory at least you calculate what retirement costs you before you bail out of work. For 9 years we've had the ACA so its been easy to project HC costs and to keep those costs low with subsidies. Moving abroad because you're forced to is a non issue (in theory) so there won't be many people who have.

I suspect there will be a few FIREes who will choose to emigrate if the choice is No ACA or go back to work.
I want to go abroad, at least for a few years, for various personal reasons. My husband is more measured so I need to sell him on this dream. ACA going away would likely make that a super easy decision for our family. If te choice is between working an extra 20 years versus moving abroad...... well, what would you choose?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5541 on: July 10, 2019, 01:17:36 PM »
Where would you go Ysette?

ysette9

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Re: What comes after the ACA?
« Reply #5542 on: July 10, 2019, 03:11:52 PM »
England!

Sorry state of affairs that their dumpster fire is still better than ours.

FIREstache

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Re: What comes after the ACA?
« Reply #5543 on: July 10, 2019, 05:47:08 PM »

I'm an American citizen only, so I don't have good options to leave the country, unless I just pay the full health care cost at the lower non-American price tag, for any health care needs I might need.  If the ACA goes away in another year or so, I think I would be better off working with the expensive American system another 8 years until Medicare kicks in, which will probably be about $500/mo in today's dollars, not exactly free.

geekette

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Re: What comes after the ACA?
« Reply #5544 on: July 10, 2019, 06:54:01 PM »

I'm an American citizen only, so I don't have good options to leave the country, unless I just pay the full health care cost at the lower non-American price tag, for any health care needs I might need.  If the ACA goes away in another year or so, I think I would be better off working with the expensive American system another 8 years until Medicare kicks in, which will probably be about $500/mo in today's dollars, not exactly free.
Yeah, except if the ACA goes away, the insurance companies will again be allowed to say that many of us are just uninsurable. 

:: waves ::

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Re: What comes after the ACA?
« Reply #5545 on: July 10, 2019, 06:54:12 PM »

I'm an American citizen only, so I don't have good options to leave the country, unless I just pay the full health care cost at the lower non-American price tag, for any health care needs I might need.  If the ACA goes away in another year or so, I think I would be better off working with the expensive American system another 8 years until Medicare kicks in, which will probably be about $500/mo in today's dollars, not exactly free.

Actually when the next nearest country pays half what we do then honestly you don't need membership of another country. Many countries welcome US expats with open arms, some even allow you to join their national schemes, but even if they don't likely you'll be paying 30 to 50% of what you pay here.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5546 on: July 10, 2019, 07:46:42 PM »

Actually when the next nearest country pays half what we do then honestly you don't need membership of another country. Many countries welcome US expats with open arms, some even allow you to join their national schemes, but even if they don't likely you'll be paying 30 to 50% of what you pay here.

Amputations are free in Mexico

Wexler

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Re: What comes after the ACA?
« Reply #5547 on: July 11, 2019, 09:56:36 AM »
I guess COBRA is good for 18 months if you will FIRE soon.  It's expensive, but it's there if your employer has you covered when you quit and has 20 employees.  I don't think they will go after COBRA.  After the 18 months, something should be worked out by then.  People will be very angry if it isn't.

COBRA could be double the cost for me, but 18 months isn't that long to have coverage, and I hate to FIRE without knowing there's going to be reliable coverage that doesn't cost me a fortune for the following 8 years.  I already had to delay FIRE an extra year because of this mess, and if it goes to SCOTUS, it looks like there may not be a final ruling until after next spring when I was hoping to FIRE.  Considering that, I might have to delay FIRE again or take a risk by jumping into the unknown.

Oh just jump. I retired 4+ years ago and the ACA had been threatened from before then. I was DONE with work and wasnt going to let political nattering stop me. Maybe I was lucky (and well we did have a COBRA policy dor the max period) but it has been fine.

Let's hope our luck holds, but what you call luck I call voting.  We are only in the position we are in to worry about the ACA because of the extraordinarily bad luck (voting) we had in 2016.  None of this would be an issue if the election had gone the other way and Merrick Garland were sitting on the court.  I hope that's a lesson to everyone who didn't bother to vote and whose retirement plans depend on the ACA.



partgypsy

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Re: What comes after the ACA?
« Reply #5548 on: July 11, 2019, 10:37:14 AM »
My brother had Medicaid through aca and if it wasn't for that, my parents would be swamped in medical bills after his 6 month bout of cancer treatment and care including hospice. Not to say there are things I wouldn't change about aca (I would make it universal and automatic) but things are better with it than without.

FIREstache

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Re: What comes after the ACA?
« Reply #5549 on: July 11, 2019, 11:20:21 AM »
My brother had Medicaid through aca and if it wasn't for that, my parents would be swamped in medical bills after his 6 month bout of cancer treatment and care including hospice. Not to say there are things I wouldn't change about aca (I would make it universal and automatic) but things are better with it than without.

Some other concerns are "balance billing" that has been discussed in this thread, and then there's the matter of a large number of claimed being denied, even on appeal:

https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/