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Old 08-20-2016, 02:21 PM   #41
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That's a very good point. I wonder why 400% of FPL was decided as the cutoff point. Also, why it was designed as a cliff rather than a slope at the higher incomes.
These are good questions, and also relevant, as the OP is addressing a very specific issue.

The most likely reason for the cliff and the 400% limit is that's all they could afford when the calculations were made and the law written. Our legislative process determines the net cost of each action and deals with self-imposed limits, and this legislation is no different. If they could have afforded more, they most likely would have done that - especially the cliff, which must be a legitimate cause for ongoing complaint.

If, at some future point in time, there were specific concern about subsidies being given to high net worth individuals, one possible remedy that already has a precedent and process in place is the clawback. Easier to approve and implement (IMHO).
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Old 08-20-2016, 02:42 PM   #42
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They had better not touch the <insert name of subsidy, incentive, or tax break that benefits me>! After all, you don't see them doing anything about <enter subsidy, incentive, or tax break that benefits a different group>, or even <enter subsidy, incentive, or tax break that benefits a different group>! The legislators should have to give up their <enter perk or benefit> before they ask me to give up anything!
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Old 08-20-2016, 02:46 PM   #43
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Well FAFSA and colleges seemed to figure what do with a combo of assets and income, I do think it's certainly possible in ACA rules. It certainly would be possible to come with a family expected contribution based on income and a % of your assets.
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Old 08-20-2016, 03:24 PM   #44
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I'd say the odds were about as good as finding a pulled pork sandwich in Mecca.
I do not have reasons to go to Mecca, oh wait, I would not even be allowed to be there. But would one be satisfied with a pulled lamb sandwich, if they have such a thing? Time for me to go search the Web to see if anybody makes a lamb or goat sandwich.

Oh wait. We just came back from a grocery run, and happened to see a newly opened grocery store. Dropped in to look around, and discovered that it was a Mediterranean store. So, I looked on their spice rack, and saw a package of Sumac. I always wanted to try it in a recipe that I found on the Web, but am too cheap to order it off Amazon. Now, I have a bag for just $2. Off to the Web I go, looking for that grilled meat dish again.
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Old 08-20-2016, 03:24 PM   #45
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They might decide to capture the whole thing on the back end and lower the estate tax exemption. What is it now, $5.5 million? Drop it to $1 million and recapture any ACA subsidies millionaires might have been getting while they were living.
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Old 08-20-2016, 03:25 PM   #46
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I do not have reasons to go to Mecca, oh wait, I would not even be allowed to be there. But would one be satisfied with a pulled lamb sandwich, if they have such a thing? Time for me to go search the Web to see if anybody makes a lamb or goat sandwich.

Oh wait. We just came back from a grocery run, and happened to see a newly opened grocery store. Dropped in to look around, and discovered that it was a Mediterranean store. So, I looked on their spice rack, and saw a package of Sumac. I always wanted to try it in a recipe that I found on the Web, but am too cheap to order it off Amazon. Now, I have a bag for just $2. Off to the Web I go, looking for that grilled meat dish again.
What about an MLT?
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Old 08-20-2016, 03:31 PM   #47
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On the topic of ACA is one proposal to lower the age of Medicare to 55 - that would benefit many on this forum
There seems to be less stigma with Medicare that ACA - something my wife ran into once.


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Old 08-20-2016, 03:34 PM   #48
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Somebody in Australia makes this sumptuous looking grilled lamb sandwich.

As for me, I just found something to try with my newly acquired bag of Sumac: grilled chicken with Sumac. See the sliced mint sprinkled on top? That also gives it a more Mediterranean flavor.

I am telling you, I do not know how I will get health insurance next year, but eating well will take your mind off things that you cannot control. And you do not have to spend a lot of money like Robbie does either.



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Old 08-20-2016, 03:52 PM   #49
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For those truly interested in some pulled pork in Mecca, just a few minutes south, about a 10 mile drive to neighboring Warren (both in Ohio) is Cockeye BBQ (here). Their pulled pork sandwich
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Pulled Pork - Our famous slow-smoked pork shoulder, lightly sauced and garnished with creamy house slaw - 3.79
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Old 08-20-2016, 04:35 PM   #50
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I could see that 400%-of-FPL being lowered, gradually. Or the 9.5%-of-MAGI. I am between 300% and 400% of FPL, so a change like that would impact me greatly (and negatively).
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Old 08-21-2016, 05:09 AM   #51
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I could see that 400%-of-FPL being lowered, gradually.
That was researched by the CBO.

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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
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Old 08-21-2016, 06:24 AM   #52
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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.
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Old 08-21-2016, 06:50 AM   #53
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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.
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Old 08-21-2016, 06:55 AM   #54
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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.
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Old 08-21-2016, 07:49 AM   #55
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I don't think the ACA will be refined, it will either continue or be repealed and something else comes in.
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Old 08-21-2016, 10:17 AM   #56
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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.
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Old 08-21-2016, 11:23 AM   #57
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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.
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Old 08-21-2016, 12:48 PM   #58
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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.
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Old 08-22-2016, 07:59 AM   #59
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What about an MLT?
Groan.....
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Old 08-22-2016, 09:01 AM   #60
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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.
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