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Fear ACA will be repealed at some point - how do you "plan" for that?
Old 12-04-2015, 06:12 AM   #1
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Fear ACA will be repealed at some point - how do you "plan" for that?

I just read this article about the possibility the ACA could be repealed in the future if certain political conditions exist.

Senate Votes to Repeal ACA for the First Time

(You may have to register to read that article.)


I don't want this to turn into a political debate. What I want to know is, if you are counting on the ACA in order to retire early, how do you deal with the uncertainty that it may be pulled out from under you once retired?

With my medical history there is no way I am insurable on the regular market. The thought that it could be taken away from me makes me very scared to pull the fully FIRED trigger (plan is for husband to retire in 2018, the year he turns 55). Should I be looking at contingency plans for how to deal with this if it happens after we retire? Or is the only contingency plan go back to work full-time for coverage? Do high-risk pools still exist?

I don't want to overreact, but I am a planner, so I want to think through how we'd handle this, if it happens. Or, is it not possible to plan for it, and we just have to take the leap, hope for the best, and know we'll find a way somehow if it happens?
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(49, married; DH 53. I am fully retired as of 2015 (well ok, I still work part-time but only because I love the job and have complete freedom to call off if I want to travel with hubby for work), DH hopes to fully retire 2018 when he turns 55 to access 401K penalty-free...although he may decide to do part-time consulting)
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Old 12-04-2015, 06:22 AM   #2
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I don't want to overreact, but I am a planner, so I want to think through how we'd handle this, if it happens. Or, is it not possible to plan for it, and we just have to take the leap, hope for the best, and know we'll find a way somehow if it happens?
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.
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Old 12-04-2015, 06:26 AM   #3
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The article doesn't list the restoration of medical underwriting or preexisting condition exclusions (PCEs) as part of the proposed package. Then again, the combination of no underwriting/PCEs *and* the elimination of a coverage mandate could likely result in massive adverse selection that could make the whole thing untenable.

Unfortunately, I don't how to build a "contingency" plan based on this. It's important to note that not necessarily every piece of ACA would likely be repealed in such a scenario. In particular, the elimination of PCEs and the extension of policies to children up to age 26 generally enjoy popular approval. I personally haven't heard these pieces of ACA under direct attack.
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Old 12-04-2015, 06:42 AM   #4
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I would doubt that any major piece of the ACA will be repealed, other than some additional asset based criteria in order to get subsidies. Once your assets would be depleted, you would still get free healthcare, no matter what.

I think there are a lot of future things that could change, this would only be be small part.

That is why you need some extra contingency money in your budget, unforeseen changes to 'stuff' you cannot control.

If you are planning on retiring on a minimal budget, with a minimal cushion, you are at a high risk of failure, regardless. That is why many people work OMY+.
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Old 12-04-2015, 07:24 AM   #5
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Like OP, I am depending upon some form of Obamacare continuing. If "unexpected" changes occur in this area, I will significantly reduce my travel spending; that is part of discretionary spending.

Any change is dependent upon who the next president will be in Jan 2017.
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Old 12-04-2015, 07:24 AM   #6
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Medical underwriting is politically unpopular enough that it seems to me extremely unlikely that it will return. In my case, worst thing is that I could stop doing Roth conversions and go on Medicaid.
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Old 12-04-2015, 07:34 AM   #7
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Things will probably be much clearer in late 2017 early 2018. Not much planning one can do on pure speculation on changed to ACA. I wouldn't spend much energy on plans other than keeping retirement date flexible.


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Old 12-04-2015, 07:36 AM   #8
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My retirement budget assumes full insurance premiums (vs reduced prices due to ACA credits.) So financially, I think I'm good. (I look at the tax credits as an un-guaranteed benefit.)

I strongly doubt that the insurance for all part would be eliminated - same with the kids on the policy till age 26.... both are far too popular.
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Old 12-04-2015, 08:02 AM   #9
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Medical underwriting is politically unpopular enough that it seems to me extremely unlikely that it will return. In my case, worst thing is that I could stop doing Roth conversions and go on Medicaid.
Unfortunately the Medicaid expansion is part of the ACA, if the ACA goes away so does the expansion. Then you would need to be elderly, blind, or disabled and have next to nothing in income and assets.
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Old 12-04-2015, 08:23 AM   #10
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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.
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Old 12-04-2015, 08:37 AM   #11
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Until this year we had an individual insurance policy with Blue Cross. When the ACA came out a few years ago insurance companies had to change their plans to mirror the ACA so pre-existing is no longer a restriction. You can buy an individual plan through an insurance broker or do what I did. Go to the insurance companies website and look up the plans and the premiums.

If your concern is not receiving a subsidy through the ACA then you might have some issues. You can still look for individual health policies in your area and might be surprised in what is available.

We will be retiring early next year and are looking at the subsidies to carry us until age 65. However, in planning for retirement we calculated the full premium in case the ACA changes or our income is to high.
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Old 12-04-2015, 08:50 AM   #12
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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.
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Old 12-04-2015, 08:50 AM   #13
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If your concern is not receiving a subsidy through the ACA then you might have some issues. You can still look for individual health policies in your area and might be surprised in what is available.

We will be retiring early next year and are looking at the subsidies to carry us until age 65. However, in planning for retirement we calculated the full premium in case the ACA changes or our income is to high.
Her concern is being excluded from getting HI at all.


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With my medical history there is no way I am insurable on the regular market. The thought that it could be taken away from me makes me very scared to pull the fully FIRED trigger (plan is for husband to retire in 2018, the year he turns 55).
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Old 12-04-2015, 08:58 AM   #14
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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.
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Old 12-04-2015, 09:07 AM   #15
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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.
Seriously? Have you set aside a couple of million $? Exactly how do you estimate the worst case medical costs you might be on the hook for?

There is a reason why medical costs are the number one reason for bankruptcy.

And that's why many people buy insurance to protect themselves from the catastrophe of enormous medical bills.
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Old 12-04-2015, 09:08 AM   #16
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I was on an individual plan before ACA and since my health hasn't changed I figure I shouldn't have a problem going back to that.

If underwriting was put back on the table and I would be rejected due to health issues, the first thing I'd do is see if there's any group insurance I could somehow qualify for. At one point before ER I joined a professional organization (I think it was IEEE) that at the time had group health. It was pricey, though, much higher than I could get on my own, and eventually they dropped it. Not sure what else is out there, but that's where I'd start.

After that I'd try to find a part-time job that allowed me in their plan, or look at one of the options of other states, or possibly another country. I'd really have to weigh the choice of moving vs. taking a job especially if it was full-time. Since I don't expect to be faced with that choice, I'm not going to spend any time worrying about it.
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Old 12-04-2015, 09:10 AM   #17
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I think that it is too soon to wait and see.
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Old 12-04-2015, 09:10 AM   #18
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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.
Great plan! What if insurers are allowed to exclude again on pre-existing conditions? Some cancer drugs cost up to $500,000.

You must have a lot of money!
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Old 12-04-2015, 09:11 AM   #19
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...
I don't want to overreact, but I am a planner, so I want to think through how we'd handle this, if it happens. Or, is it not possible to plan for it, and we just have to take the leap, hope for the best, and know we'll find a way somehow if it happens?
I do not follow the ACA news but occasionally see scare articles about Social Security and Medicare. I actually expect some changes especially Medicare but not ones that will bust our personal budget.

There is no way to totally plan for the future but we all know our time on Earth is limited. Hence our need to ER and get on with the good life. In an election year, expect plenty of posturing as these guys all want to gather power. I'd not take it seriously and I'd plan for continuity with modest changes in government programs.
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Old 12-04-2015, 09:21 AM   #20
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The article doesn't list the restoration of medical underwriting or preexisting condition exclusions (PCEs) as part of the proposed package...
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Medical underwriting is politically unpopular enough that it seems to me extremely unlikely that it will return...
Prior to ACA, I paid a bit more than $600/month for health insurance for 2, with a deductible of $10K. I was in good health then.

Now, with PCE ruled out (and I myself developing an existing condition), I found that an equivalent plan costs about $1K/month. I can still pay that, and cut back elsewhere if needed.
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