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Old 03-21-2014, 11:45 PM   #41
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Originally Posted by ERhoosier View Post
Greece is an economic basket case after decades of overly generous spending on social benefit programs the nation could not afford. It's an economy remaining afloat only via EU bailouts. Even Sweden, the historical bastion of social welfare, pulled back after overall public spending ht 70+% of GDP.

I'm not saying all subsidies in ACA are bad, but to the extent they DIScourage productivity they risk harming the economy. The overall standard of living, inc HC spending/benefits, of any country ultimately depends on per capita GDP. A directed HI tax credit to individuals, NOT their employers, would sever the HI/j#b link & let folks pursue vocations/interests they enjoy. Inc. PT, FT, or OT w#rk without affecting their HI arrangement. Happy w#rkers tend to be more productive, and many successful small (& not so small) businesses started out as hobbies.
Most of the developed countries, except the U.S., all have some form of universal health care, and their economies aren't all like Greece.

Here's a Map of the Countries That Provide Universal Health Care (America's Still Not on It) - Max Fisher - The Atlantic

Many countries with universal health care and strong social support systems in rank high in terms of GDPs, some higher than the U.S. -

List of countries by GDP (PPP) per capita - Wikipedia, the free encyclopedia

Don't all other countries in the E.U. have some form of universal health care? And most of them do not have the same economic issues as Greece?

I agree with you on severing the job / health insurance link completely. The ACA helps many people who post here who have mom and pop businesses, are stay at home parents, or early retires able to live off pensions / investments / rental income / part time work. I don't see us all as a bunch of slackers and drags on the economy. I never thought of myself as an unproductive slacker when I was a stay at home mom.
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Old 03-22-2014, 10:48 AM   #42
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The Iquit resulting from ACA is also a boon for the younger people entering the workforce. Many companies don't want to put the money out to train new people, if the old people retire then they have no choice but to train. This could very well be the biggest ACA benefit to our economy 20 years from now
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Old 03-22-2014, 11:19 AM   #43
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Most of the developed countries, except the U.S., all have some form of universal health care, and their economies aren't all like Greece.

Here's a Map of the Countries That Provide Universal Health Care (America's Still Not on It) - Max Fisher - The Atlantic

Many countries with universal health care and strong social support systems in rank high in terms of GDPs, some higher than the U.S. -

List of countries by GDP (PPP) per capita - Wikipedia, the free encyclopedia

Don't all other countries in the E.U. have some form of universal health care? And most of them do not have the same economic issues as Greece?

I agree with you on severing the job / health insurance link completely. The ACA helps many people who post here who have mom and pop businesses, are stay at home parents, or early retires able to live off pensions / investments / rental income / part time work. I don't see us all as a bunch of slackers and drags on the economy. I never thought of myself as an unproductive slacker when I was a stay at home mom.

I only said there are practical limits to overall COSTS relative to per capita GDP. I made NO comment either opposing "universal access to care" nor saying that it was incompatible with a reasonably strong economy.
BTW- According to WHO reports, "universal access" in many countries is not so universal in practice. Benefits are not unlimited, and most HC systems are under increasing economic stress. Co-pays ("user charges")are now common, inc in France for some services. Care delays and "service dilution" tend to be increasing, which WHO notes are mechanisms of "implicit rationing".
http://www.euro.who.int/__data/asset...865/e96643.pdf
In Greece the chronically unemployed can lose HI, and many "eligible" for care simply cannot afford the hi co-pays.
http://www.bbc.com/news/business-17067104
OTOH- I find it interesting that in practice, the much praised French HC system is surprisingly similar to US (mix of gov't & private insurance with private pay option).
http://www.theatlantic.com/business/archive/2012/03/france-and-us-health-care-twins-separated-at-birth/254033/
Bottom line is that there's no free lunch in HC, and no nation claims to have a perfect HC system. Cost is #1 problem worldwide, and clearly most acute in US.

BTW- I have no problem with stay-at-home moms (or dads). Raising children is important work, and for many families this is a most practical & economically sensible arrangement. Nor are truly FI ER's a "drag on the economy". Their investment/spending of accumulated assets & volunteering efforts (formal & informal) can contribute significantly to fabric of society. IMHO- FIRE is like saving up for a (hopefully very long) vacation. It can be a good thing for those who want it & can afford it ($$ & mentally).... but not so good if means using someone else's credit card to pay for it.
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Old 03-22-2014, 02:20 PM   #44
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Our lady house cleaner was here yesterday and told us a story about how the ADA has affected her. She takes some special kind of medicine and her insurance company sent a letter saying it was no longer covered. However, there was a new plan she could opt to have, an ACA plan that would then cover her medicine. The plan premium was $460/mo. She said it was twice what she was paying and had made a decision. She'll be 62 in two years so she has decided to drop the insurance and pay the fine/penalty for those two years. I don't quite understand all this and glad I'm not involved in Obamacare. However, if I was involved, it would mean that I was a lot younger and that would be a good tradeoff.
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Old 03-22-2014, 03:10 PM   #45
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But remember that workers in employer-based plans are not taxed on the employer subsidy portion of the premium, so they are also getting a government subsidy but in an indirect manner. The ACA subsidies merely try to even out this inequity.
Also in many corporations they have a plan that allows employee contributions to be taken out of the paycheck before tax so that in that case the total cost of the HI is taxfree. It is often called a benefit cost reduction plan. This is not often discussed, but works only with wages, you can't do it till above 10% medical costs if paying with other money.
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Old 03-22-2014, 04:33 PM   #46
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Also in many corporations they have a plan that allows employee contributions to be taken out of the paycheck before tax so that in that case the total cost of the HI is taxfree. It is often called a benefit cost reduction plan. This is not often discussed, but works only with wages, you can't do it till above 10% medical costs if paying with other money.
Yup. Back in my working days, I was able to use pretax dollars to pay for my share of the premiums starting in 1990 or so.

I have complained a few times in this forum about the unequal tax treatment of health insurance premiums, from the (1) non-taxation of the employer portion to the (2) use of pretax dollars to pay for premiums to the (3) use of after-tax dollars to pay for premiums. When I was in a group plan, it was a combination of (1) and (2) but as an early retiree it became at best a combination of (2) and (3), sometimes only (3) because of the increase to 10% of AGI the amount of premium excluded.
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Old 03-22-2014, 04:56 PM   #47
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Our lady house cleaner was here yesterday and told us a story about how the ADA has affected her. She takes some special kind of medicine and her insurance company sent a letter saying it was no longer covered. However, there was a new plan she could opt to have, an ACA plan that would then cover her medicine. The plan premium was $460/mo. She said it was twice what she was paying and had made a decision. She'll be 62 in two years so she has decided to drop the insurance and pay the fine/penalty for those two years. I don't quite understand all this and glad I'm not involved in Obamacare. However, if I was involved, it would mean that I was a lot younger and that would be a good tradeoff.

I don't think she will have to pay the fine, now. Regs have been changed and now all she has to do is state the ACA cost more than previous plan or is unaffordable and she is exempted from the penalty.


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Old 03-22-2014, 04:58 PM   #48
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And the fact that the younger, healthy generation is not signing up will ultimatley drive the cost of the ACA upwards over the coming years. It's great that individuals with pre-existing conditions can now get insurance, but what happens in the future when it becomes unaffordable? And wasn't the biggest reason Obama's plan was enacted so that the 30-45 million (depending on who you ask) unisured in this country could get AFFORDABLE healthcare? Guess that's not working!
We don't actually know yet the age mix or totals that will have signed up by the March 31 deadline. In my state (the big one!), young people were running slightly ahead of predictions as of the end of last month. The Kaiser Family Foundation also does not believe that a low rate of sign up by the younger demographic will have a significant effect on rates:

The Numbers Behind “Young Invincibles” and the Affordable Care Act | The Henry J. Kaiser Family Foundation

We also have the example of Massachusetts and Switzerland on whose HI systems the ACA was based. Switzerland has the second highest per capita cost of healthcare behind only the US, but it does have universal healthcare provided by private insurance companies. Obviously, there are more efficient solutions, but the current political climate is unlikely to permit transition to a better approach. Like a majority of primary care docs, I'm pro-single payer myself, even if it is an 80/20 system like France as ERHoosier has pointed out.
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Old 03-22-2014, 05:29 PM   #49
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Yup. Back in my working days, I was able to use pretax dollars to pay for my share of the premiums starting in 1990 or so.

I have complained a few times in this forum about the unequal tax treatment of health insurance premiums, from the (1) non-taxation of the employer portion to the (2) use of pretax dollars to pay for premiums to the (3) use of after-tax dollars to pay for premiums. When I was in a group plan, it was a combination of (1) and (2) but as an early retiree it became at best a combination of (2) and (3), sometimes only (3) because of the increase to 10% of AGI the amount of premium excluded.
+1

I also had access to an FSA which enabled prescription drugs, OTC drugs, eye tests and spectacles etc to paid with before tax $.

My retiree group insurance is from the same employer but is now paid with after tax $, no FSA available, and because it is a low deductible plan is not eligible for an HSA.
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Old 03-22-2014, 06:38 PM   #50
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The prior health care insurance environment almost derailed my ER back in 2003. I thought that since a reasonable WD( less than 4%) rate from my NW had my financial requirements covered I was ready for ER.

It never occurred to me that a history of (controlled) high BP in my case and carpal tunnel in my wife's case would mean that I couldn't find individual health insurance AT ANY PRICE based on our preexisting conditions. The only way I was able to get insurance was to create a home business and then get a group plan (for two people!). I am so glad that our current health insurance environment came into being! Hopefully no future ER person will have to go thru the year of miserable anxiety re health insurance we had to live back then.
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Old 03-22-2014, 07:19 PM   #51
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We would still be w*rking without the ACA despite our assets. Knowing that we had access to insurance was a key part of our retirement. We do not in any way qualify for a subsidy.

My mom fell off a cliff and broke her tibia, had a plate put in and then had it taken out because she is a jock. When my dad retired she was unable to get insurance that covered that leg. She's now 78 and hasn't had a problem with the leg for over a quarter of a century. When my cow*rkers mom had a colonoscopy at 50, they found diverticulae and so she was unable to get insurance at her older husband's retirement. She's now 78 too and hasn't had a colon problem ever. A patient finally got pregnant with a much desired baby late in life. The baby was found to have a fatal heart defect on ultrasound. When she was born she was taken from the OR where her mom had a C-section directly to the OR where the heart problem was corrected. The "baby" is now in a top rated PhD program, doing great, but "uninsurable". My BIL has two flaps on one of his heart valves rather than three. He is completely healthy, hikes as a hobby, runs a thriving one man business, and lives at high altitude. He is also "uninsurable" except through a high cost "high risk pool". I can keep telling these stories. None of these people are lazy, asking for a hand-out, or even sick. They have insurance for their homes and their cars and they just want insurance for their health care too.
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Old 03-22-2014, 10:52 PM   #52
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Our lady house cleaner was here yesterday and told us a story about how the ADA has affected her. She takes some special kind of medicine and her insurance company sent a letter saying it was no longer covered. However, there was a new plan she could opt to have, an ACA plan that would then cover her medicine. The plan premium was $460/mo. She said it was twice what she was paying and had made a decision. She'll be 62 in two years so she has decided to drop the insurance and pay the fine/penalty for those two years. I don't quite understand all this and glad I'm not involved in Obamacare. However, if I was involved, it would mean that I was a lot younger and that would be a good tradeoff.
Did she actually look for insurance through one of the exchanges? I find it curious that our ACA premiums would be so much lower than a house cleaners. The plan our insurance company sent us cost $1,500 a month for a non-exchange plan. Our Bronze plan rate from the exchange is currently under $200 a month.
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Old 03-23-2014, 12:16 AM   #53
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If I quit and have no income, just live off my assets for the next few years, then I would qualify for expanded Medicaid coverage under my state's plan. Assets are no longer considered. So long as my asset income does not exceed about $16500/year I get free health insurance?

I don't think this was an intended outcome of healthcare subsidy.

What happens next year when ACA plans triple their rates as we hear some states expect (Florida) because the user population is so heavily skewed to older people?
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Old 03-23-2014, 12:52 AM   #54
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If I quit and have no income, just live off my assets for the next few years, then I would qualify for expanded Medicaid coverage under my state's plan. Assets are no longer considered. So long as my asset income does not exceed about $16500/year I get free health insurance?
That's the way it's been working for me.
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Old 03-23-2014, 07:14 AM   #55
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Originally Posted by JOHNNIE36 View Post
Our lady house cleaner was here yesterday and told us a story about how the ADA has affected her. She takes some special kind of medicine and her insurance company sent a letter saying it was no longer covered. However, there was a new plan she could opt to have, an ACA plan that would then cover her medicine. The plan premium was $460/mo. She said it was twice what she was paying and had made a decision. She'll be 62 in two years so she has decided to drop the insurance and pay the fine/penalty for those two years. I don't quite understand all this and glad I'm not involved in Obamacare. However, if I was involved, it would mean that I was a lot younger and that would be a good tradeoff.
The insurance company directs their members to plans that generate the most profit for the insurer. She needs to shop around and compare plans taking into account any premium subsidy she may be eligible for. It's like saying the Ford Escort is no longer available as a new car but we can put you in a new Ford Taurus but after shopping around you find the Ford Focus is an appropriate substitute.
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Old 03-23-2014, 07:23 AM   #56
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I was, and remain, a fervent supporter of the ACA, even with its flaws. I have a pre-existing condition -- brought on a few years ago by a stress-related job incident -- and I was utterly uninsurable on my own. I could find no coverage at all, let alone at a decent premium.

I will soon be one of the 2 million or so who will be "losing" their jobs in the next year -- when I hand in my notice. The ACA will (it already really is) the fourth rail of American politics. As of today, March 23, 5.5 million are projected to be enrolled and paid through the exchanges. Millions more are covered by the under-26 provisions of the law. And millions more "woodworkers" came out of the woodwork to claim Medicaid benefits. The ACA is the next social security.

ACA is flawed, but I was imprisoned by the totally legit fear of bankruptcy if I left my high-paying, but very stressful job. The ACA is the light at the end of the tunnel for me. And that light is fresh air and sunshine -- not an oncoming train.
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Old 03-23-2014, 07:25 AM   #57
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If I quit and have no income, just live off my assets for the next few years, then I would qualify for expanded Medicaid coverage under my state's plan. Assets are no longer considered. So long as my asset income does not exceed about $16500/year I get free health insurance?
Medicaid rules vary by state. Depending on the state and your age, a portion of your estate may, or may not, be subject to "clawback" after your passing.

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Old 03-23-2014, 08:08 AM   #58
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Did she actually look for insurance through one of the exchanges? I find it curious that our ACA premiums would be so much lower than a house cleaners. The plan our insurance company sent us cost $1,500 a month for a non-exchange plan. Our Bronze plan rate from the exchange is currently under $200 a month.
Don't know if she did any searching on her own. Just said that her current insurance company told her what a ACA plan would cost.
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Old 03-23-2014, 08:22 AM   #59
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Don't know if she did any searching on her own. Just said that her current insurance company told her what a ACA plan would cost.
Did she evaluate whether she would get a subsidy? Either way, there is so much misinformation flying around that these anecdotes are virtually useless.
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Old 03-23-2014, 08:52 AM   #60
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Medicaid rules vary by state. Depending on the state and your age, a portion of your estate may, or may not, be subject to "clawback" after your passing.

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Thanks Gamecock. That's pretty frightening for my scenario. I'm not quitting soon, but will hope there is a way around this where I can just buy a policy in the future and not be forced onto Medicaid.

I agree with the comments on eliminating pre-existing condition exclusions and creating pooled rates. There were just so many more ways to do this that would have been more effective. My state for example had already enacted this independent of ACA and years before. So the available policy care was actually better here than what ACA has rolled out now. It is yet another disappointment in our legislature that they had to overcomplicate the entire scheme so horribly. That's what happens when the healthcare lobbyists get to influence how bills are written. Its just a bad evolution of our system.
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