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Old 03-27-2010, 09:32 AM   #141
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My guess is that all assets (including retirement assets and property/real estate) will probably be assessed as income-equivalent under some type of "expected annual distribution" calculation. From the taxpayer's perspective, I think that's fair, though it might end up hurting me personally.
Our policy should be that public assistance is for those who can't help themselves. On the other hand, I think everyone who qualifies under the present rules should take every penny available.
+1 Yeah, even though we rightly look out for number one, at the same time we should be concerned with what is the best public policy. Whether we agree with this legislation or not, it is probably here to stay. We will soon begin years of fixing the fixes. Maybe how best to do that can become a new thread after the November election when things (hopefully) settle down a bit.
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Old 03-28-2010, 04:13 AM   #142
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Originally Posted by Ken11 View Post
Well, IM retiring this weekl.
I have employer subsidized HC between now and Medicaire.
However, the new law causes megacorp to give up the tax deduction that had applied to this expense.
So, a few firms are now taking write offs and threatening to reduce retiree HC benefits. Wonderful.
I'm not even retired yet an my benefoits are at risk cause of the new bill.
I am in the same situation.

The govt will provide temporary reinsurance to encourage companies to not drop HC coverage for early retirees for the next 4 years until the state HC exchanges are available. Unless companies wind up in really bad shape, they probably will not drop their HC retirement plans before the exchanges open. It is bad publicity and breeds mistrust with current employees. It would also kill any chances of having an near-term ER programs to encourage older/higher paid employees to ER and off the payroll.

However, this legislation is a game changer. It would not surprise me to see employers shift early retirees off to the exchanges over time once they have determined how to manage the transition. There could be several outcomes:

  1. Continue with status quo. I doubt this will happen over the long haul. This new program offers a number of new possibilities for employers to get the expense of their balance sheet. But, if some employers can do it cost effectively and provide a better benefit to employees, they may see it as an opportunity to attract better employees.
  2. Cut ER health care benefits all together so people wind up using the state HC exchange program.
  3. Shift to providing Corporate HC benefits by giving an ER a subsidy (or employer match) to cover premium cost of using the HC exchange.
  4. Shift to providing Corporate HC benefits by rebating Out of Pocket expenses of ER and Full Retirees.
  5. Combination of 2 and 3
  6. Provide supplemental insurance to fill certain gaps.

One thing this bill does is help people to better understand their worst case scenario (in terms of premium cost and perhaps HC cost burden) and therefore manage their personal risk. While HC inflation will continue, you can move forward with much less risk of losing coverage altogether because an employer drops their plan or due to some set of health circumstances causing you to be denied coverage by an insurance company or paying massive premiums that are completely unaffordable. It also seems to ban the old practice of just denying claims.

You can bet companies are doing their analysis.

This is a few months old, but still fairly close.
http://www.ebri.org/pdf/briefspdf/EB...8_RetHlth1.pdf
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Old 03-28-2010, 05:41 AM   #143
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This is for the person who asked about what the insurance would cost with various numbers of people in your household. What does the health-care law mean to me? (washingtonpost.com)
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Old 03-28-2010, 08:27 AM   #144
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However, this legislation is a game changer. It would not surprise me to see employers shift early retirees off to the exchanges over time once they have determined how to manage the transition. There could be several outcomes:

  1. Continue with status quo. I doubt this will happen over the long haul. This new program offers a number of new possibilities for employers to get the expense of their balance sheet. But, if some employers can do it cost effectively and provide a better benefit to employees, they may see it as an opportunity to attract better employees.
(Italics added) This is another unintended consequence to watch for. It's important to remember that, as much as employers (rightly) complain about the high cost of medical insurance for employees--they don't have to pay it. There's never been a law requiring employers to provide health insurance. They only do it because it helps attract employees, and because they have a "special situation" (tax breaks and the ability to buy group coverage) that allows them to buy insurance more cheaply than consumers can buy it themselves. It really is an (unfair?) advantage that allows employers to attract good employees at lower cost.

Now, if (as many believe) the exchanges become the health care ghetto where care is substandard and waits are long, employers will still retain the advantage they have today. It probably won't be worth it for them to cover retirees, but to get the best employees they might sweeten the pot with better coverage (or supplemental insurance that lifts people out of the need to rely on getting all care through the exchanges).
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Old 03-28-2010, 08:47 AM   #145
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...
Now, if (as many believe) the exchanges become the health care ghetto where care is substandard and waits are long, employers will still retain the advantage they have today...
The current incarnation uses health insurance companies and the existing system. I doubt that will occur. Longer waits could occur if supply cannot meet demand.

I suspect there will be some sort of program (incentive) to attract more graduates to medical school. The govt took over the student loan program. They will loan funds to MD students at special rates (and possibly forgive the loan if they sign up for work in certain areas of the country).

Also, the US is still a very attractive country for foreigners. We are more likely to siphon off doctors from other countries.... especially if the government or health care providers create some sort of incentives.

I believe you are looking at the next job boom (over the next 20 years)... health care.

A huge number of jobs will be created in health care directly. Those jobs will give people spending money that will cause other jobs to be created in local towns (i.,e local economies).

It will be somewhat similar to the IT/Internet boom in the 1990's

With the IT technology, Internet, video streaming, and electronics available today, this change is likely to a big boost for health care delivery innovation. IMO we are getting ready to see new industry offshoots emerge... America is good at innovating.
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Old 03-28-2010, 10:12 AM   #146
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This is for the person who asked about what the insurance would cost with various numbers of people in your household. What does the health-care law mean to me? (washingtonpost.com)
Thanks. When it says "Your maximum out-of-pocket costs for deductibles and co-payments would be capped at 27% of the total cost." what does "total cost" refer to?
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Old 03-28-2010, 10:22 AM   #147
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IMO we are getting ready to see new industry offshoots emerge... America is good at innovating.
I'd say that America's private sector is good at innovating. Companies don't innovate for fun, they do it to increase profits, and everyone benefits. Insurance companies operating within the exchanges are best viewed as "semi-private", much more like public utility companies than fully private ones. Has your electric company done much "innovating?" The government will tell the health insurance companies how much they must spend on providing services vs investing in new ideas and enhanced efficiency. They tell them what must be in their product. With the government subsidizing most of their customers, you can bet there will be caps and restrictions. Don't look for any innovation in an environment like this. The lines will grow longer and the insurance companies will keep collecting their mandated 20% to administer things for the government.

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A huge number of jobs will be created in health care directly. Those jobs will give people spending money that will cause other jobs to be created in local towns (i.,e local economies).
Maybe, but only if health care costs rise. They are sure to rise under the new law (as everyone admits we've increased demand without increasing supply). So, this will increase the % of GDP we spend on health care (which was supposed to be addressed under reform, but somehow it wasn't dome). All the new money being spent on health care is coming from somewhere else, and if it comes from the government (for the newly expanded Medicaid or subsidies provided to those buying insurance through the exchanges) then it was taken out of the productive private sector via taxes (largely from those with a proven record of productively using captital). It's a spiral down, as Europe has learned.
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Old 03-28-2010, 11:08 AM   #148
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Maybe, but only if health care costs rise. They are sure to rise under the new law (as everyone admits we've increased demand without increasing supply). So, this will increase the % of GDP we spend on health care (which was supposed to be addressed under reform, but somehow it wasn't dome).
How much costs rise remains to be seen. We are adding insurance/coverage, but most already receive health care in some way. Unfortunately, it is usually inefficient and expensive.

The 35 million uninsured isn't a static list. People are in and out of insurance coverage depending on their job, family situation, age, and even where they live.
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Old 03-28-2010, 01:15 PM   #149
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If that is correct it is an important distinction for long term care purposes. I always understood that old folks could only qualify for Medicaid's LTC benefits if they burned up all their assets. I thought that even included homes. Are 401ks/IRA's homes, pension income excluded?
Under the way the law has been they don't necessarily have to sell their home but there will be a medicaid lien on it which will have to be paid before the house is sold or after the second spouse dies. 401k and pensions effected eligibility for medicaid, both on an income and asset basis.
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Old 03-28-2010, 01:19 PM   #150
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(Italics added) This is another unintended consequence to watch for. It's important to remember that, as much as employers (rightly) complain about the high cost of medical insurance for employees--they don't have to pay it. There's never been a law requiring employers to provide health insurance. They only do it because it helps attract employees, and because they have a "special situation" (tax breaks and the ability to buy group coverage) that allows them to buy insurance more cheaply than consumers can buy it themselves. It really is an (unfair?) advantage that allows employers to attract good employees at lower cost.

Now, if (as many believe) the exchanges become the health care ghetto where care is substandard and waits are long, employers will still retain the advantage they have today. It probably won't be worth it for them to cover retirees, but to get the best employees they might sweeten the pot with better coverage (or supplemental insurance that lifts people out of the need to rely on getting all care through the exchanges).
This will contribute to continue to make individual health insurance very expensive and I continue to question the stability of that market given the big benefits given employer based insurance. People will continue to run towards employer based insurance if they can. It was outrageous to me that the law makes it even harder to deduct individual heath premiums (raising the threshold to over 10% AGI from 7.5%).
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Old 03-28-2010, 01:23 PM   #151
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Ultimately, it will depend on what the voters think. It's a good thing to encourage folks to save for retirement, so excluding retirement accounts makes sense from that perspective. On the other hand, the public as a whole get restless when they are barely getting by, can barely afford shoes for the kids, and are paying taxes so that people with $500K in the bank can get public assistance.
My guess is that all assets (including retirement assets and property/real estate) will probably be assessed as income-equivalent under some type of "expected annual distribution" calculation. From the taxpayer's perspective, I think that's fair, though it might end up hurting me personally.
Our policy should be that public assistance is for those who can't help themselves. On the other hand, I think everyone who qualifies under the present rules should take every penny available.
Maybe more likely only certain assets would be exempt from counting when determining eligibility, like 401ks, pensions and homes. Which would kill me as I have no home, no pension and a dinky 401k.
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Old 03-28-2010, 02:41 PM   #152
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(Italics added) This is another unintended consequence to watch for. It's important to remember that, as much as employers (rightly) complain about the high cost of medical insurance for employees--they don't have to pay it. There's never been a law requiring employers to provide health insurance. They only do it because it helps attract employees, and because they have a "special situation" (tax breaks and the ability to buy group coverage) that allows them to buy insurance more cheaply than consumers can buy it themselves. It really is an (unfair?) advantage that allows employers to attract good employees at lower cost.

Now, if (as many believe) the exchanges become the health care ghetto where care is substandard and waits are long, employers will still retain the advantage they have today. It probably won't be worth it for them to cover retirees, but to get the best employees they might sweeten the pot with better coverage (or supplemental insurance that lifts people out of the need to rely on getting all care through the exchanges).
This is my point of view also. Even in the UK which has a government run national health care system, employers have been offering private health care insurance since the 70's (could have been earlier but this was when the first employer I worked for started offering it). To attract the best they need to distinguish themselves from the pack.

For retirees they don't have the same incentive so are more likely to stop providing their own coverage for this group.
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Old 03-28-2010, 03:14 PM   #153
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To attract the best they need to distinguish themselves from the pack.
How do they determine who the bests are?

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For retirees they don't have the same incentive so are more likely to stop providing their own coverage for this group.
Since they are no longer useful for us, let's just stop the coverage and forget about them.
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Old 03-28-2010, 03:36 PM   #154
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Thanks. When it says "Your maximum out-of-pocket costs for deductibles and co-payments would be capped at 27% of the total cost." what does "total cost" refer to?
I think it is an actuarial value – an estimated total yearly expense. The cap would be 27% of the actuarial value.
I’m sure this made everything much clearer...

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Now, if (as many believe) the exchanges become the health care ghetto where care is substandard and waits are long, employers will still retain the advantage they have today. It probably won't be worth it for them to cover retirees, but to get the best employees they might sweeten the pot with better coverage (or supplemental insurance that lifts people out of the need to rely on getting all care through the exchanges).
A big assumption. Another possibility is public employees health care, Federal and some State, is moved onto the exchanges, and this enables policy offerings that are more competitive.

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It was outrageous to me that the law makes it even harder to deduct individual heath premiums (raising the threshold to over 10% AGI from 7.5%).
Ditto that. A real disappointment. Together with the “Cadillac plan tax” I suspect this means the intention is to tax all health care benefits – making people aware of the real, total costs and motivating people to reduce usage.
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Old 03-28-2010, 04:17 PM   #155
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A big assumption. Another possibility is public employees health care, Federal and some State, is moved onto the exchanges, and this enables policy offerings that are more competitive.
We did see a quote from the law from someone in an earlier post indicating that Congress critters - at least new ones - will get their plans through the exchanges. I don't know if it is in the final plan but Obama and Pelosi kept mentioning it.
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Old 03-28-2010, 04:19 PM   #156
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The last I heard was that the 'staff' of the Washington elite would shop at the exchanges but not the elite themselves. i.e. the actual elected officials. It sounded believable to me.
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Old 03-28-2010, 04:43 PM   #157
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How do they determine who the best are?
The usual way, qualifications, interviews and experience.

The best candidates will have applied to and got job offers. In evaluating the job offers candidates look at the whole package - salary, vacation, bonus levels, health insurance etc. For example I remember when my megacorp changed it's hiring offer to include an extra 10 days vacation for a degree or equivalent experience, which was particularly attractive to both new graduates and experienced professionals that did not want to start again accumulating vacation.


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Since they are no longer useful for us, let's just stop the coverage and forget about them.
Maybe I'm concerned about this since I am now in this situation and can see fewer reasons to continue this perk. If my megacorp does stop offering this I only hope they grandfather in those already retired. They cut back health benefits for retirees about 10 years back but only for new retirees starting at the end of the year. This actually hurt them at the time as there was a rush of very experienced people who had their "80 points" to retire before the reduced benefits kicked in.
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Old 03-28-2010, 05:02 PM   #158
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section 1312: the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act).
Well, for sure, members of congress. All Federal employees - not sure.
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Old 03-28-2010, 05:03 PM   #159
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If you are worried about supply of doctors, hospitals, and nurse outstripping actual demand then you should ER in a place where 90% of the people there already have healthcare. This would be a place where 40% of the population is already retired and the other 60% work in professional jobs which provide healthcare.

There are places like that..... And I think that they will show up more.

But while I'm recommending it for anyone who is really worried about it, I feel uncomfortable in doing so because it seems to say that you should find an elitist place to live where people are not affected by any of this. For example: Move to Los Alamos,NM or West Chester,NY......

Unfortunately not all of us can afford to actually do that.

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Old 03-28-2010, 05:07 PM   #160
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The last I heard was that the 'staff' of the Washington elite would shop at the exchanges but not the elite themselves. i.e. the actual elected officials. It sounded believable to me.
The quote from MichaelB specifically says "Members" and staff.
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