ACA, Subsidies and Better off Americans (which means many FIRE)

[MBSC]

I could see that 400%-of-FPL being lowered, gradually.

That was researched by the CBO.

Eliminate Exchange Subsidies for People With Income Over 300 Percent of the Federal Poverty Guidelines

This option would cap the income level at which premium subsidies were available in the exchanges at 300 percent of the FPL. Accordingly, people with income between 300 percent and 400 percent of the FPL who bought insurance through the exchanges would no longer qualify for those subsidies. Eligibility for cost-sharing subsidies would remain capped at 250 percent of the FPL.

Under current law, roughly 1 million exchange enrollees in 2015 will have income between 300 percent and 400 percent of the FPL, according to estimates by the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT), and about 70 percent of them will receive premium subsidies.

Details: https://www.cbo.gov/budget-options/2013/44891

 

[Corporateburnout]

That was researched by the CBO.

Details: https://www.cbo.gov/budget-options/2013/44891

Before the ACA, MA had its own healthcare mandate that was enacted back in 2006. Subsidies were capped at an income of 300% of FPL.

 

[aaronc879]

Before the ACA, MA had its own healthcare mandate that was enacted back in 2006. Subsidies were capped at an income of 300% of FPL.

When I first read the details of the ACA I was shocked that the subsidies went to people with that high of an income. I think it would be reasonable to go down to 300% or even 250% to match the cost sharing cap. I know some people on here would not be happy about that but I think it would be a fair way to cut costs if needed.

 

[Pilot2013]

When I first read the details of the ACA I was shocked that the subsidies went to people with that high of an income. I think it would be reasonable to go down to 300% or even 250% to match the cost sharing cap. I know some people on here would not be happy about that but I think it would be a fair way to cut costs if needed.

I didn't like the ACA at all until I started thinking about ER and what it could do "for me". I think in a way, that says it all?

Before the sanctimonious comment start coming about my selfishness, I do feel bad about it.

 

[jim584672]

I don't think the ACA will be refined, it will either continue or be repealed and something else comes in.

 

[NW-Bound]

Pre-ACA, I had an individual policy with a $10K annual deductible. It was very simple: I paid the 1st $10K 100%, after that the insurer paid 100%. There was no copay, no coinsurance. It was a PPO policy, and I could go to any doctor I wanted without any referral. There was no red tape due to that high deductible. If I wanted to waste my money up to $10K, the insurer did not care. And if I got sufficiently sick to spend more than $10K, then it had to be really serious.

The insurance premium was about $600/month for the 2 of us in 2014, the last year we had it. I had no preexisting condition when I signed up in 2006, and the premium was a lot lower. They cannot offer this now under ACA, and I suspect that the existing plan has died because of attrition.

Again, I do not know what choice of insurer I will have next year, if any. Meanwhile, all I can do is to try to live the good life I still have. Right now, I am going to marinate a couple of Cornish hens with sumac and other spices, then roast them for dinner tonight.

 

[pb4uski]

What you describe in the first paragraph is similar to a ACA PPO bronze policy except the deductible today is higher.

If I had a bronze policy the deductible would be $6,550 ($13,100 for 2) and the premium for two is ~$800/month. While preventative care is covered, the insured pays negotiated rates up to the deductible and the insurer pays anything above the deductible so it has the simplicity you dscribe. The only hitch is that you have to use network providers but in our case, since BCBS is the largest of two insurers offered, their network is pretty good.

 

[brewer12345]

I expect nothing will happen until the system breaks and our elected officials are forced to do something about it (and maybe not even then). In the meantime it is far to politically profitable for both parties to use it as a partisan issue to rile up their base and generate campaign funds.

 

[gauss]

What about an MLT?

Groan.....

 

[FUEGO]

I don't know about the ACA angle, but I do know I'm about to walk into my kitchen (a Mecca of food for me anyway) and eat an Eastern NC style pulled pork sandwich. We roasted 20 lbs of pork shoulder yesterday so that means good eats for a while.

And thankfully I won't have to do a cholesterol blood test to qualify for health insurance during open enrollment this fall.

 

[brucethebroker]

When I first read the details of the ACA I was shocked that the subsidies went to people with that high of an income. I think it would be reasonable to go down to 300% or even 250% to match the cost sharing cap. I know some people on here would not be happy about that but I think it would be a fair way to cut costs if needed.

I believe that those numbers are produced by residents of D.C. Have you been there lately? Average nice home in the suburbs is at least twice the price of Midwest homes.

Obviously, DC'ers think anyone below 400% actually live in poverty. Of course, if you don't have a mortgage, or car payments, a couple can actually live on $62k a year.

 

[Mulligan]

If someone really wants the ACA "death spiral" to occur try this....Give something free or greatly subsidized to people then turn around and yank it away from them. I am sure they will be just running to find the checkbook after seeing the unsubsidized costs.
But, Im in the do nothing camp. My land they cant even agree on properly funding the mosquito virus issue...What are the odds of anything in ACA being agreed to?


Sent from my iPad using Tapatalk

 

[LastOfTheBoomers]

Since I live in a state that has under 2 Million people - but borders a bigger state with many more health plans that offer more choices with less cost - I would want to see the cross border limitation removed.

 

[ChiliPepr]

What do others think is the likelihood that ACA could be modified after election to eliminate subsidies for those with low income, but high assets? In other words many on this Forum...

I think this is a tough question to answer until you can tell me how a person with a $75k COLA pension and no money in the bank is treated versus a person with no pension and $2 million in the bank is treated.

How do you define and value assets? Cash? Property? Gold? Diamonds? Art? Annuities?

 

[Senator]

If someone really wants the ACA "death spiral" to occur try this....Give something free or greatly subsidized to people then turn around and yank it away from them. I am sure they will be just running to find the checkbook after seeing the unsubsidized costs.
But, Im in the do nothing camp. My land they cant even agree on properly funding the mosquito virus issue...What are the odds of anything in ACA being agreed to?

Exactly. The genie is out of the bottle. Other mechanisms will come in play to control medical costs.

 

[MRG]

Since I live in a state that has under 2 Million people - but borders a bigger state with many more health plans that offer more choices with less cost - I would want to see the cross border limitation removed.

Not sure where you are but when we were in KC many of the plans for MO included providers on the KS side.

 

[Mr._Graybeard]

Since I live in a state that has under 2 Million people - but borders a bigger state with many more health plans that offer more choices with less cost - I would want to see the cross border limitation removed.

The trick will be finding an out-of-state plan that your doctor or medical group will accept.

 

[GTFan]

I think this is a tough question to answer until you can tell me how a person with a $75k COLA pension and no money in the bank is treated versus a person with no pension and $2 million in the bank is treated.

How do you define and value assets? Cash? Property? Gold? Diamonds? Art? Annuities?

Just curious, is there anything that's asset tested under federal income tax code? How would they do that in a verifiable manner?

Asset tests were considered and rejected for the ACA, btw. I highly doubt this will be part of any future reforms.

 

[daylatedollarshort]

I've updated our retirement plan to assume losing the ACA tax credits after this year and that the premium pricing will go from the current 3 to 1 to 5 to 1 for the pre-Medicare age group. The subsidies were nice while they lasted. Our retirement plan was made before the ACA existed so overall any years with tax credits were still a plus for us.

If the premiums end up lower then that will be great, otherwise the money for the full freight premiums has been set aside and budgeted for. I'm in the acceptance phase of my five stages of grief now over the likely ACA repeal.

 

[MBSC]

Since I live in a state that has under 2 Million people - but borders a bigger state with many more health plans that offer more choices with less cost - I would want to see the cross border limitation removed.

Three states already allow this but no insurers have taken advantage of it since the mandates (covered services) are similar. Premiums are a function of costs with MLR in place. Apparently, medical services either cost more in the small state or residents are less healthy and use more medical services. If residents in the small state could buy the large state's plans, they would still be priced to reflect the higher medical costs.

Everything is rated for the locality of the service....whether you buy it across state lines or not, you are going to pay the rates for the locality in which you use the services. The only logic that "buying across state lines" makes is the ability to buy a plan in a state that lowers mandates.

So, let's say that an OK based insurer sells a product without all of those NY mandates, but prices it for NY zipcodes. The premium would be less for New Yorkers, because there are fewer benefits mandated.

It also brings adverse selection to a national scale. So, let's say that one NY family chooses Oklahoma-based insurance (rated for their NY zip code) because the mandates are the least. The next NY family, with a special medical condition, picks coverage from another state that happens to mandate benefits for that condition. Bingo - adverse selection.

So, then, why would any carrier sell IFP from any state other than the one with the fewest mandates? It's a great race to the bottom.

Buying Across State Lines - pt 1
Buying Across State Lines - pt2

 

[NW-Bound]

I've updated our retirement plan to assume losing the ACA tax credits after this year and that the premium pricing will go from the current 3 to 1 to 5 to 1 for the pre-Medicare age group. The subsidies were nice while they lasted. Our retirement plan was made before the ACA existed so overall any years with tax credits were still a plus for us.

If the premiums end up lower then that will be great, otherwise the money for the full freight premiums has been set aside and budgeted for. I'm in the acceptance phase of my five stages of grief now over the likely ACA repeal.

That's why many of us prefer to see the health care costs reduced, instead of let stay artificially high and then subsidized by the government. Even the government can and will run out of money, so that would not be long lasting.

 

[Texas Proud]

Just curious, is there anything that's asset tested under federal income tax code? How would they do that in a verifiable manner?

Asset tests were considered and rejected for the ACA, btw. I highly doubt this will be part of any future reforms.

I think that you are being too narrow by saying 'federal income tax code'... there are subsidies that are asset tested... student loans and grants being one... Medicaid being another..... well, at least it was... not sure of the states who did not expand... OH, CHIPS... welfare....

The ACA does not have to look at just the federal tax code if the gvmt does not want to limit itself....

 

[samclem]

I The ACA does not have to look at just the federal tax code if the gvmt does not want to limit itself....

Right, and any new construct wouldn't necessarily need to use the IRS as the "collection agent," either. Merging the government's "general fund" taxation functions with health insurance may offer some efficiencies, but also has definite problems. E.g. under the ACA, a couple must file MFJ to get an ACA subsidy. This isn't always a good answer, or even possible.

 

[GTFan]

That's why many of us prefer to see the health care costs reduced, instead of let stay artificially high and then subsidized by the government.

The problem here is that this is the hardest thing to do, given the constituencies and the massive influence that they have over the pols. We can't even agree to let Medicare negotiate drug prices but the VA and DoD can, fer cryin' out loud.

 

[GTFan]

Right, and any new construct wouldn't necessarily need to use the IRS as the "collection agent," either. Merging the government's "general fund" taxation functions with health insurance may offer some efficiencies, but also has definite problems. E.g. under the ACA, a couple must file MFJ to get an ACA subsidy. This isn't always a good answer, or even possible.

Well yeah but now you're in pure blue sky speculation mode, not anything based on what we have now.