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Old 08-29-2016, 05:57 PM   #61
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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 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.
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Old 08-29-2016, 08:27 PM   #62
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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?


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Old 12-22-2016, 05:46 AM   #63
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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.
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Old 12-22-2016, 06:38 AM   #64
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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?
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Old 12-22-2016, 07:39 AM   #65
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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.
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Old 12-22-2016, 07:54 AM   #66
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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.
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Old 12-22-2016, 08:55 AM   #67
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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.
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Old 12-22-2016, 09:09 AM   #68
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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.
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Old 12-22-2016, 09:55 AM   #69
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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.
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Old 12-22-2016, 10:28 AM   #70
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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.

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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
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Old 12-22-2016, 10:28 AM   #71
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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.
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Old 12-22-2016, 10:37 AM   #72
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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....
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Old 12-22-2016, 10:57 AM   #73
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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.
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Old 12-22-2016, 08:48 PM   #74
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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.
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Old 12-22-2016, 08:50 PM   #75
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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.
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Old 12-23-2016, 01:57 AM   #76
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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 doubt the structure of ACA will be preserved, as many appear to be assuming. There are still 28-30m uninsured, though all now have "access". If you analyze the uninsured the largest category is people who choose not to afford it, including a number of folks who qualify for subsidies.

I think what we will see is tiers of coverage and prices for same and fewer subsidies. Pre-existing conditions covered as long as you remain insured. High risk pools for people that used to be "uninsurable". And better pricing for the rest.

I expect folks like us will buy what we are willing to pay for, same as housing and cars.

YMMV and mine may also. Just a guess.
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Old 12-23-2016, 10:23 AM   #77
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I doubt the structure of ACA will be preserved, as many appear to be assuming. There are still 28-30m uninsured, though all now have "access". If you analyze the uninsured the largest category is people who choose not to afford it, including a number of folks who qualify for subsidies.

I think what we will see is tiers of coverage and prices for same and fewer subsidies. Pre-existing conditions covered as long as you remain insured. High risk pools for people that used to be "uninsurable". And better pricing for the rest.

I expect folks like us will buy what we are willing to pay for, same as housing and cars.

YMMV and mine may also. Just a guess.

From what I read, not all have access.... at least on the article I read... they said 21% and not legal, so would not be eligible for ACA plan...


But, I do wonder how much they can actually change... if they want to 'require' access and keep some of the other benefits, somebody has to pay the costs... so it might not be revenue neutral....


I will say that I was surprised to learn of some people who do not have insurance... I take a class at the gym... one lady got sick and was in the hospital for a week (she is in her 40s).... talking to another lady there I found out she did not have insurance.... that she had just paid off a big bill from some other problem in her family when they also did not have insurance... I do not know what she or her husband does, but it did surprise me...

So I mentioned that I was on Obamacare and was surprised sick lady did not have a plan... then the lady talking to me said her family did not have a plan!!! Said her husband was self employed and they could not afford it... I said she could probably get a cheap plan if they income was so low... maybe $200 a month cost to them.... her comment "We cannot afford $200 per month".... Sooooo.... at least a family of 3 (she brings her daughter in as she is home schooled) and maybe more and you do not think health insurance is important enough to pay $200 per month
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Old 12-23-2016, 10:34 AM   #78
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And yet, she can take classes at the gym....money is sometimes just the excuse, though for the life on me, I can't understand this attitude.
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Old 12-23-2016, 11:42 AM   #79
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And yet, she can take classes at the gym....money is sometimes just the excuse, though for the life on me, I can't understand this attitude.
Do not a make judgements on this since you do not know... the cost of the class is ZERO and the gym membership is $10 plus tax per month...
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Old 12-23-2016, 11:51 AM   #80
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Do not a make judgements on this since you do not know... the cost of the class is ZERO and the gym membership is $10 plus tax per month...
Can't speak to this particular case, but I think that the general sentiment is valid that many don't think that having health care is a spending priority. When the uninsured get free care, it is off the backs of those that have already stepped up to pay for their own care.
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