Fear ACA will be repealed at some point - how do you "plan" for that?

[daylatedollarshort]

However, it looks like that analysis doesn't consider the impact of whatever replaces it in the unlikely event ACA is repealed. I don't see a lot of momentum to repeal and do nothing... more to repeal and replace... and until there is some clarity on what the replacement would be it is impossible to estimate the impacts.

Replace is certainly always a possibility, but it has been several years now since the ACA has been crafted and I have not seen any politically tenable full replacement proposals developed yet.

 

[Fermion]

I personally do not think ACA will suffer much change. It isn't the type of program where you can keep the parts you like and remove the parts you don't like as that makes the whole not work.

The only way now that they can scrap ACA is to move to single payer, which would also solve the OP's problem. About 400,000 people would be unemployed then, which means that option is also off the table.

The most likely outcome by far then is that there is a lot of talk and no action. That is where I would place my betting money.

 

[simple girl]

simple girl, your concern is certainly legitimate, but you really can't build a specific contingency plan because we don't know what the "replacement" scenario looks like. Health care coverage is about access and cost. For financial planning purposes I assume we will always need to pay full cost with no subsidy, including Medicare. As for access, no plan but lots of hope, in the past we found a way.

OK, you and several others suggested projecting being able to pay full premiums if need be, so I will model for that financial scenario as well, in case they take the subsidy part away. Thank you!

There is no way to model for the scenario that I may be uninsurable if they take away access to those with pre-existing conditions. That would require one of us to return to work for benefits, so we just have to be ready to accept that is a remote possibility. I'm not going to let that remote possibility keep us from retiring early. I've learned nothing is promised in this life!

 

[pb4uski]

Replace is certainly always a possibility, but it has been several years now since the ACA has been crafted and I have not seen any politically tenable full replacement proposals developed yet.

True, but I'm not aware of anyone who proposes repeal and do nothing.. which was my point (and what the CBO analysis was based on).

 

[simple girl]

Simplegirl, It's hard for me to say how I would feel now as I'm almost 61 and only a few years away from Medicare, but I remember how desperate I was to retire at age 55 and I did budget to pay full price for HI should my Megacorp pull the rug.

However, I didn't have a medical condition that would automatically exclude me from HI under the old system so I understand why that would be a huge concern. For now my advice would be to wait and see, 2018 is a long time politically and the picture may be clearer then. IIRC you have an occupation that is in demand so you could plan to RE at 55 with the knowledge that you could always get a job with HI if need be.

Yes, you are absolutely right. Good point! Even if I retire for several years, it is highly likely I can get a job in my profession easily. Thank goodness for a good career choice in terms of job security!

 

[foxfirev5]

I personally do not think ACA will suffer much change. It isn't the type of program where you can keep the parts you like and remove the parts you don't like as that makes the whole not work.

The only way now that they can scrap ACA is to move to single payer, which would also solve the OP's problem. About 400,000 people would be unemployed then, which means that option is also off the table.

The most likely outcome by far then is that there is a lot of talk and no action. That is where I would place my betting money.

Spot on. This is where I'm placing my money , by taking ER in '16 for better or worse.

 

[pb4uski]

....There is no way to model for the scenario that I may be uninsurable if they take away access to those with pre-existing conditions. That would require one of us to return to work for benefits, so we just have to be ready to accept that is a remote possibility. I'm not going to let that remote possibility keep us from retiring early. I've learned nothing is promised in this life!

As another poster mentioned you may be able to get access to group insurance which is not underwritten.

In our first year of retirement (pre ACA) I formed an LLC for consulting, joined the local chamber of commerce, and then bought into their group health insurance program. I did it because it was more affordable but it also ducks medical underwriting.

Or move residence to a state that prohibits medical underwriting and buy insurance there.

 

[simple girl]

I'm not too worried about it. Possible contingency plans:

1. Relocate to a state with universal coverage/ACA type healthcare. Massachusetts for example. Vermont? I imagine many other states (probably blue - hope that's not too political to say!) who currently enjoy the universal coverage aspect of the ACA might keep it in some form or another. The longer the ACA remains in place, the more it becomes status quo and considered a "right".

2. Relocate to overseas destination - Thailand and Mexico are commonly mentioned here but YMMV. It's a huge step just to get healthcare.

3. Go back to work, quit, get COBRA. Repeat.

4. Emigrate to a developed nation (they all have some form of public healthcare but there are strings attached and barriers to entry).

None of these have to be permanent solutions. You can come back at age 65 and get Medicare. Assuming Medicare remains intact.

For our plans, I'm pretty sure we can afford the premiums as long as we are paying for an average policy. If they ever go back to risk-priced, then we might be screwed if we have a medical issue that puts us in high risk territory.

Worst case, there's a starbucks down the street, so maybe I can learn to be a middle-aged barista. Working with a bunch of 19 year olds might keep me young, too.

Ha ha ha thanks Fuego, good list to keep for reference! Appreciate the humor as well!

 

[simple girl]

I would plan to pay for all health expenses using your own money. Then if an insurance company or government pays instead it is a bonus.

Impossible. It would ruin us financially. I feel bad for my current insurance company. God knows how much they've paid out for my care over the past 5 years. I've never been more thankful for good insurance coverage. Hoping the worst expenses are behind me, but I still have one more reconstruction surgery to go (5 so far, radiation fibrosis sucks).

 

[jim584672]

Xxxxx Xxxxx wants to repeal Obamacare and replace it with "something terrific"...

Pfhew, and I was getting nervous for nothing. "Something terrific" sounds fantastic.

 

[Texas Proud]

I personally do not think ACA will suffer much change. It isn't the type of program where you can keep the parts you like and remove the parts you don't like as that makes the whole not work.

The only way now that they can scrap ACA is to move to single payer, which would also solve the OP's problem. About 400,000 people would be unemployed then, which means that option is also off the table.

The most likely outcome by far then is that there is a lot of talk and no action. That is where I would place my betting money.

It is not like all those people would be laid off... the gvmt would have to hire a bunch of people to handle the claims...

Single payer is not like some other countries where they also hire the docs, own the hospitals etc. etc...

Medicare is single payer and there is still a lot of fraud etc. and people that handle claims...

 

[Texas Proud]

As another poster mentioned you may be able to get access to group insurance which is not underwritten.

In our first year of retirement (pre ACA) I formed an LLC for consulting, joined the local chamber of commerce, and then bought into their group health insurance program. I did it because it was more affordable but it also ducks medical underwriting.

Or move residence to a state that prohibits medical underwriting and buy insurance there.

Interesting.... did you actually have a legit business or just a shell


Also, what about AARP or some other large group.... do they have an option that people might be able to use without underwriting?

 

[simple girl]

We retired in the pre Obamacare days (2003) and found that we were unable to purchase individual health care policies at any price due to pre existing conditions. What we ended up doing was to create a small hobby business and then as a business, we were able to purchase a group policy (for a group of 2!) Lousy, very expensive policy but it was better than nothing. Obamacare was a godsend. I suppose that approach would still be an option if Obamacare were to be repealed.

Oh we could definitely do that. Great idea. I love that I am developing a list of contingencies, just in case. Makes the planner in me feel better.

 

[Fermion]

I do like the "move to a state with universal healthcare" as a fallback option actually. I think we would do this instead of going back to work in the 0.01% chance ACA is repealed with insurers being able to go back to their old ways (I can just see the rescission parties they would be having).

5% income tax and 6% sales tax doesn't sound too bad if you have very low income anyway and already have purchased one of everything that exists like we have.

 

[meierlde]

Interesting.... did you actually have a legit business or just a shell


Also, what about AARP or some other large group.... do they have an option that people might be able to use without underwriting?

Note that I belonged to the American Association of Petroleum geologists and before they had a set of insurance polices that you would pay a 50% premium increase if otherwise uninsurable. Of course those policies no longer exist. Further they also had a 50,000 deductable major medical policy.

 

[Theseus]

OK, you and several others suggested projecting being able to pay full premiums if need be, so I will model for that financial scenario as well, in case they take the subsidy part away. Thank you!

There is no way to model for the scenario that I may be uninsurable if they take away access to those with pre-existing conditions. That would require one of us to return to work for benefits, so we just have to be ready to accept that is a remote possibility. I'm not going to let that remote possibility keep us from retiring early. I've learned nothing is promised in this life!

Simple Girl - Although I might be able to include myself in the category of cancer survivors I don't like to think of myself as such, because in my case it was caught (neuroendocrine tumor) so very early that other than a colectomy and heading into the 5th year of followups, life has been no different for me. Those who I would say are the true survivors have had much greater challenges to face.

But one thing for sure, and I sense you feel it as well - is the sense of mortality one becomes so aware of when facing such a disease. Staring that in the face drove my ER decision-making process, and I was determined to make the best of it rather than continuing to waste my time making the megacorp hamster wheel spin along as if everything was just fine. Being that I am still 6-1/2 years from medicare coverage myself, the future of ACA is definitely on my radar. When trying to peel away the layers of the doom vs. gloom reports of repeal, I've usually found that at a minimum there was some form of cooldown period of up to two years where little would change, then followed by something either pared down, or even a rebranded duplication of many of the same provisions.

Pretty much puts me in the sit back and see what happens <yawn> group. And no regrets over my ER decision, no matter what happens.

 

[Fermion]

It is not like all those people would be laid off... the gvmt would have to hire a bunch of people to handle the claims...

Single payer is not like some other countries where they also hire the docs, own the hospitals etc. etc...

Medicare is single payer and there is still a lot of fraud etc. and people that handle claims...

I figure the people that have been hired to run ACA could transition to the claims handling on the single payer, or an equivalent exchange of jobs.

The insurance industry employs something like 3 million people. I don't know the breakdown but I bet a million of those are health insurance related.

Maybe we could so some variant of cash for clunker degree thing.

 

[simple girl]

I now have a pre-existing condition and am taking a costly drug ($10 a pill per day) which is covered or mostly covered. I would absolutely dread losing the ACA and either be woefully underinsured or be paying through the nose for an individual plan which covered my new pre-existing condition (if one existed). My whole ER would be in danger because making it to age 65 (Medicare age) financially intact would become a real challenge. I have a good stockpile of money but how could I budget for 20-25% annual increases in premiums as well as high OOP costs for my expensive drug?

Exactly!

I think our contingency plan if things change in the ACA to the point where we are excluded or it is too expensive has to be - back to work for one of us. I will also work on projections for significant increases in premiums/OOP/no subsidies. We could retire right now on a close budget, but hubby is willing and wants to work 2 more years to pad it. Smart man. I think I'll keep him.

It is what it is. Better to acknowledge the risk upfront. There is only so much financial cushion I can project to protect us; at some point we'd never retire early if we tried to plan for the absolute worst case scenario.

 

[simple girl]

We live in MA and when we first considered early retirement we were counting on enrolling in Romney care. If the ACA is to ever be repealed our state will go back to Romney care. One of the main differences between the two plans is the MA universal system income qualification for subsidies stops at 300% of poverty rather than 400% for the ACA.

Simple girl, you're more than welcome to move to MA if the ACA is repealed.

Ha ha ha! Love that! You bet we will if that happens! Thanks for the invite!!!

 

[simple girl]

Hawai'i had near-universal HI prior to the ACA. Can you afford to move there? I imagine that California would get on board with a MA style plan pretty quickly too, if the ACA went away. The legislature passed one way back when, but the Governator vetoed it.

I don't honestly think that the ACA will go anywhere. It'll mostly just be used as a fund raising issue. However, my spouse is eligible for citizenship in an EU country and I've been married to him long enough to qualify too.

Oooh, I like the Hawaii option, too. Have always wanted to retire there, but thought it was too far from family. But if my hand was forced.... You guys are great. Thanks for helping me see the bright side. Gotta keep a sense of humor about all these unknowns!

 

[simple girl]

Simple Girl - Although I might be able to include myself in the category of cancer survivors I don't like to think of myself as such, because in my case it was caught (neuroendocrine tumor) so very early that other than a colectomy and heading into the 5th year of followups, life has been no different for me. Those who I would say are the true survivors have had much greater challenges to face.

But one thing for sure, and I sense you feel it as well - is the sense of mortality one becomes so aware of when facing such a disease. Staring that in the face drove my ER decision-making process, and I was determined to make the best of it rather than continuing to waste my time making the megacorp hamster wheel spin along as if everything was just fine. Being that I am still 6-1/2 years from medicare coverage myself, the future of ACA is definitely on my radar. When trying to peel away the layers of the doom vs. gloom reports of repeal, I've usually found that at a minimum there was some form of cooldown period of up to two years where little would change, then followed by something either pared down, or even a rebranded duplication of many of the same provisions.

Pretty much puts me in the sit back and see what happens <yawn> group. And no regrets over my ER decision, no matter what happens.

Yes, facing your own mortality definitely changes a person. Death is a great teacher...if we listen to what it has to tell us!

It all makes me very anxious to get hubby retired and do everything we can before anything else happens. My prognosis is excellent...but the fear of recurrence always lingers in the back of my mind. I've had multiple false (thankfully!) alarms of recurrence in the past 4.5 years. Each time is a reality check. It makes me more willing to take some risks than I might have been in the past. All we have is now, this present moment.

 

[youbet]

Exactly!

I think our contingency plan if things change in the ACA to the point where we are excluded or it is too expensive has to be - back to work for one of us.

I have no dog in the fight as I'm on Medicare.......

But my thought would be that the aspect of the ACA that guarantees access to insurance, without regard to preexisting conditions, will remain intact. However, the subsidies may be subject to reformulation. I sense the middle class folks who wind up subsidizing ACA HI for other middle class folks are questioning some of the rules.

If you still had guaranteed access but premiums went up a bit to reflect the actual group cost and if subsidies went away, would that put your FIRE status in jeopardy? If so, I'd be worried about retiring too.

That is, I wouldn't walk away from a decent job if that meant I'd be absolutely counting on gov't subsidies in order to have HI.

 

[simple girl]

If you still had guaranteed access but premiums went up a bit to reflect the actual group cost and if subsidies went away, would that put your FIRE status in jeopardy? If so, I'd be worried about retiring too.

That is, I wouldn't walk away from a decent job if that meant I'd be absolutely counting on gov't subsidies in order to have HI.

Agreed. I need to run the numbers/projections on that. We wouldn't be ready right now at full premium level, but I'm pretty sure we'll be there in 2 years.

I hope! If not, well, better to accept reality and adjust our plans.

 

[M Paquette]

Just be sure to factor in the 5.15% flat income tax, car/boat excise tax and 6.25% sales tax before you load up the truck!

Luxury! We've got 9.3% (with bumps higher at megabuck/year income) income tax, 8.5% sales tax, and assorted other fees and taxes. And we have to live in an old water tank on a rubbish tip!

Summary: Life is expensive. Loath it or ignore it, you can't like it. Life...

 

[pb4uski]

Interesting.... did you actually have a legit business or just a shell...

Well, that is a good question. When I formed the LLC I had just retired and Mega had expressed some interest in my doing some consulting and I was open to it and I thought I might do some consulting here and there. In the end, they didn't call me and I was fine with it and i didn't call them or chased any other opportunities so I never generated any revenue.

The LLC's corporate policy was to pass the cost of health insurance on to its employees (me) and I just paid the premium directly to the insurer even though technically I probably should have paid it to the LLC and had the LLC pay it to the insurer. I never get questioned on it... I don't think they cared as long as the chamber got its membership dues and the insurer got its premiums.