Obamacare

[Texas Proud]

If Intuit or another company isn't seeing this whole ACA thing as a HUGE business opportunity, they are very foolish. Software allowing a person to optimize their choices is going to be very valuable, especially if it can integrate with the customer's tax return information. The ideal software will also get right down to the state level, allowing people to see and choose from the available options (by company, by "bronze," "silver," and "gold" level, etc) in each "exchange". The software could allow users to see/decide on SS withdrawal strategies, 401K withdrawal strategies, tIRA-to-Roth conversion strategies, etc, etc

Optimization software would easily be worth a couple hundred dollars to many folks. There's no way a few government web sites or info pamphlets will allow a user to cut through the morass of "what-if" scenarios presented by this program (and the other interdependent government programs--tax code, SS, etc).

Two thoughts on this.... first, the vast majority of people are not going to even care one way or the other... most working people will get their insurance from their company... if you do not, then you are likely not making a lot of income and would qualify without doing anything... you then have the people who might benefit, but are clueless... so the potential market for this produce is small (or smallish)...


Second, I do not know what potential liability the company would have if they messed up... IOW, the program says 'do this and you get X credit'.... and something happened and they did not get it... the cliff is pretty big for some people..... I can see class action lawsuit lawyers lining up to sue...

A tax program is different... you either owe the tax or do not owe the tax... if the program makes a mistake, it will not cost the company a big amount because you are still responsible for the tax....

 

[Brat]

Two thoughts on this.... first, the vast majority of people are not going to even care one way or the other... most working people will get their insurance from their company... if you do not, then you are likely not making a lot of income and would qualify without doing anything... you then have the people who might benefit, but are clueless... so the potential market for this produce is small (or smallish)...
....

I don't think you realize that the vast majority of people who work for small businesses or who have a small business do not have access to health insurance except through the individual market. The potential market is huge.

I agree that there are a lot of people who will be unable to figure this out. For a while, in Oregon, if a person showed up in the emergency room without insurance they were signed up for the Oregon Health Plan (Medicaid) and qualifying income sorted out later. Perhaps there will be a designated default health care policy as a part of state offerings.

 

[Texas Proud]

I don't think you realize that the vast majority of people who work for small businesses or who have a small business do not have access to health insurance except through the individual market. The potential market is huge.

I agree that there are a lot of people who will be unable to figure this out. For a while, in Oregon, if a person showed up in the emergency room without insurance they were signed up for the Oregon Health Plan (Medicaid) and qualifying income sorted out later. Perhaps there will be a designated default health care policy as a part of state offerings.

Yes, I do realize that... but I would bet that the people who work for small business that do not offer health care are low paid people... IOW, below the line anyhow.... if it is small business that have high wages, they probably offer healthcare... now, I could be completely wrong in my thinking..... but don't care enough to do any research....

 

[marko]

Do you have a cite for the exception you are thinking of?

I"ve been searching and found nothing.

I may have confused it with the plan to include SS as part of MAGI. Underlines are mine.

From House Report 112-254:
"...Specifically, the bill revises the definition of modified
adjusted gross income for purposes of eligibility for the
premium assistance credit for health insurance purchased
through an exchange--sometimes referred to as an exchange
subsidy--to include the amount of Social Security benefits and
tier 1 Railroad Retirement benefits that are not includible in
gross income. This definition of modified adjusted gross income
applies also for purposes of eligibility for reduced cost-
sharing with respect to health insurance purchased through an
exchange and for Medicaid for the nonelderly and the Children's
Health Insurance Program...."

 

[rbmrtn]

Our company policy is the same for everybody.... young and old... and the two biggest users of health care in our company are on the young side... one guy has a young girl who just hurts herself all the time... another has a wife who had breast cancer...

I think that is part of differences in group plans and individual plans. Group is under a different set of federal regulations and must cover all employees and can't charge individuals in the group more for conditions/age. Individual plans can be cherry picked/rejected for the same conditions accepted in a group plan. As I recall my megacorp didn't have age based premiums.

I also recall we a fellow whose wife developed MS, and cost a fortune in treatment. In the prior year he was a top performer, after he was rated as needing improvement and then gotten rid of. We all thought it suspicious he was let go when their medical claims skyrocketed.

 

[JoeWras]

possible problems with signing up for Obamacare subsidies.



To Sign Up For Obamacare, Start Filling Out The Forms Now (And Hire A Good Accountant) - Forbes


i looked at the copy that will be the online form if you want a subsidy. all i can say is wow.


actual link to instruction form


http://waysandmeans.house.gov/uploadedfiles/pdf_cms_1_031313.pdf

Interesting. But I think the author of the Forbes article didn't read it very well. The instruction form is really a review for the govt. committee. It says in the preface:

The online application is

a dynamic process that’s tailored based on the application filer’s responses to
questions and the electronic verification of data available during the application process.


You can followconditional logic through the italicized directions in the questionnaire
—
these wouldn’t appear on the
screen.

In other words, a well developed web app would skip most questions based on previous input. Now, whether the govt. programmers come up with a good web app is another question...

Even the paper form at 21 pages is mostly repetition for each person in the household. If you have only yourself and spouse, it is shorter.

 

[gerrym51]

Interesting. But I think the author of the Forbes article didn't read it very well. The instruction form is really a review for the govt. committee. It says in the preface:

In other words, a well developed web app would skip most questions based on previous input. Now, whether the govt. programmers come up with a good web app is another question...

Even the paper form at 21 pages is mostly repetition for each person in the household. If you have only yourself and spouse, it is shorter.

the advice of getting an accountant might be right

 

[gerrym51]

the government is hiring people to help you enroll in the ACA


Tens of thousands Obamacare 'navigators' to be hired | WashingtonExaminer.com



http://www.ofr.gov/OFRUpload/OFRData/2013-07951_PI.pdf

additonal explanation
http://thehill.com/blogs/healthwatc...91655-hhs-sets-rules-for-obamacare-navigators

 

[MichaelB]

The thread is open again after a bit of whittling down. We were discussing implementation related aspects of the PPACA and invite everyone to help keep it on topic.

 

[FinanceDude]

2014 is the key year to see how costs change, how the exchanges are going to work, etc. I think a number of large insurance companies are either going to go out of business or merge with others. The pool of insureds will be larger but much sicker, so the insurance companies will have to compensate somehow, but their reimbursements will be much lower, so that cost will be borne by someone.

Private group insurance will go the way of the dodo, it will be cheaper for companies to drop the coverage they offer to their employees and go into an exchange. The landscape will look far different three years from now. Will the level of care be better? Maybe, maybe not, but we will have to wait and see........

 

[ziggy29]

The pool of insureds will be larger but much sicker, so the insurance companies will have to compensate somehow, but their reimbursements will be much lower, so that cost will be borne by someone

The pool probably will be sicker, in large part because the tax/penalty for going uninsured wasn't steep enough.

But yes, I would tend to agree that we will see some shorter-term volatility in pricing until the insurers have a handle on pricing it appropriately. Though I would expect some volatility into 2015 as well, as they may need some claims history under PPACA to figure out where they need to price their products to be remain both competitive and profitable.

 

[bUU]

2014 is the key year to see how costs change, how the exchanges are going to work, etc. I think a number of large insurance companies are either going to go out of business or merge with others.

That's actually been predicted (by Weiss Ratings) for this year. Aetna and Coventry Health Care merged last summer. I think such corporate movements will continue to the happen, as they have happened in the past.

The pool of insureds will be larger but much sicker

That's not likely, as one main impact of ACA is the health insurance requirement imposed on younger adults, who, relying on their youth and health, used to take their chances and go without health insurance. I remember working with a young guy 15 years ago. He had a good job, working as a junior programmer in a major health care provider's (if you can believe it) corporate offices. His choice was to take the money he would have spent on health insurance and instead spend it on ski trips. It was rather unfortunate when he broke his leg skiing.

Private group insurance will go the way of the dodo, it will be cheaper for companies to drop the coverage they offer to their employees and go into an exchange.

It's always been cheaper not to offer health insurance. Yet companies did offer it. ACA represents only an incremental change in that. Our insurance plan here at work has been effectively ACA-compliant for years. My guess is that I can plan on having health insurance provided to us at work for the ten years until I retire.

 

[aja8888]

Two thoughts on this.... first, the vast majority of people are not going to even care one way or the other... most working people will get their insurance from their company... if you do not, then you are likely not making a lot of income and would qualify without doing anything... you then have the people who might benefit, but are clueless... so the potential market for this produce is small (or smallish)...
....

Besides many people working in small companies where it's possible that those companies will drop employee health coverage (I know of two nearby already thinking about that), there are millions (a large number) of people who are self employed consultants, tech specialists, etc. who will be impacted by this program.

 

[ziggy29]

That's not likely, as one main impact of ACA is the health insurance requirement imposed on younger adults, who, relying on their youth and health, used to take their chances and go without health insurance.

But because the penalty (or tax if you prefer) for going uninsured is *much* lower than the cost of even a qualified Bronze plan, they may still rely on their youth and health, pay the tax and stay out of the pool.

Frankly (and I admit this is a little bit of editorializing) I think that if they really wanted to more or less totally remove adverse selection, the penalty needed to be equal to the subsidized cost of the lowest priced qualifying plan. That would seem to remove all financial incentives to go uninsured. As I recall, the insurance companies welcomed "no underwriting" and "guaranteed issue" as long as everyone was required to "play". Many insurers have noted, though, that the penalties for not playing aren't enough to get everyone into the pool. If costs rise because the pool of insured is sicker, this could be a big reason why.

 

[bUU]

But because the penalty (or tax if you prefer) for going uninsured is *much* lower than the cost of even a qualified Bronze plan, they may still rely on their youth and health, pay the tax and stay out of the pool.

True, but the penalty will still motivate some more people to do the right thing. I haven't seen any data showing that more "sicker" people will materialize from somewhere (remember: we've already been paying for indigent care through pass-through fees applied to every bill for services to an insured) and enter into the nation's health care system, and I surely haven't seen any data showing that the number of such people will exceed the number of younger people moving into the system because the penalty motivates them to do so.

 

[samclem]

Frankly (and I admit this is a little bit of editorializing) I think that if they really wanted to more or less totally remove adverse selection, the penalty needed to be equal to the subsidized cost of the lowest priced qualifying plan.

Not to get too far afield, but I still think there are free-market ways to induce people to buy this insurance that don't involve govt taxes/fines. If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.


Make "Insured/uninsured" status public information and a lot of industries will use it in their calculations. It won't be a total answer, but part of the answer. It could be instituted as part of the implementation of the rest of the law, when we find out (no surprise) that a large number of people are still not signing up.

 

[bUU]

If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.

Brilliant! I'd suggest that every place where there is, or by all rights should be, an exculpatory clause posted ("You should not ride this amusement park ride if you have a bad back." "You should be in good health to ski"), should be required to check proof of health insurance. Besides amusement parks and ski areas, I'd suggest shooting ranges, health clubs, child play areas, etc.

 

[REWahoo]

Not to get too far afield, but I still think there are free-market ways to induce people to buy this insurance that don't involve govt taxes/fines. If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.

Make "Insured/uninsured" status public information and a lot of industries will use it in their calculations. It won't be a total answer, but part of the answer. It could be instituted as part of the implementation of the rest of the law, when we find out (no surprise) that a large number of people are still not signing up.

In theory I really like this approach. In practice I don't think it would be a solution.

Our state requires you have liability insurance to buy a car and that rule is well enforced. Problem is there is no way to prevent the buyer from dropping coverage immediately after the purchase. The only way they are found out is after having an accident. Yes, it's against the law, but it doesn't seem to stop a huge number of people from doing it.

 

[REWahoo]

Brilliant! I'd suggest that every place where there is, or by all rights should be, an exculpatory clause posted ("You should not ride this amusement park ride if you have a bad back." "You should be in good health to ski"), should be required to check proof of health insurance. Besides amusement parks and ski areas, I'd suggest shooting ranges, health clubs, child play areas, etc.

Would it be possible to have a reasoned conversation without the excessive sarcasm?

 

[Gatordoc50]

Not to get too far afield, but I still think there are free-market ways to induce people to buy this insurance that don't involve govt taxes/fines. If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.

Make "Insured/uninsured" status public information and a lot of industries will use it in their calculations. It won't be a total answer, but part of the answer. It could be instituted as part of the implementation of the rest of the law, when we find out (no surprise) that a large number of people are still not signing up.

Individual Insurance status is protected by HIPAA. An individual would have to volunteer that information.

 

[samclem]

In theory I really like this approach. In practice I don't think it would be a solution.

I agree, but together with the fines (taxes) and the subsidies, it could help.

And there's a more controversial step: After we've done all the above, as a society, to help a person to do the responsible thing and take steps within their means and ability to get coverage, I think it will be time to re-examine the idea of "on demand" health care for those who don't do their part. That can be part of implementation, too. It needn't be immediate, and it's likely to be a natural result of the public "discussion" we have on this subject. I think people will get fed up when all we're asking is very reasonable (and heavily subsidized) actions.

 

[Mulligan]

But because the penalty (or tax if you prefer) for going uninsured is *much* lower than the cost of even a qualified Bronze plan, they may still rely on their youth and health, pay the tax and stay out of the pool.

Frankly (and I admit this is a little bit of editorializing) I think that if they really wanted to more or less totally remove adverse selection, the penalty needed to be equal to the subsidized cost of the lowest priced qualifying plan. That would seem to remove all financial incentives to go uninsured. As I recall, the insurance companies welcomed "no underwriting" and "guaranteed issue" as long as everyone was required to "play". Many insurers have noted, though, that the penalties for not playing aren't enough to get everyone into the pool. If costs rise because the pool of insured is sicker, this could be a big reason why.

If I understand this correctly and I have read this on more than one occassion, when it gets down to it, there is no penalty. I have been told here that Mass. does it differently, but for the federal program, the only means of collection is through withholding tax refunds and that is the sole means. Adjust your withholding correctly, and the fine will never be collected.

 

[bUU]

Would it be possible to have a reasoned conversation without the excessive sarcasm?

Huh? No sarcasm was expressed or implied there. I really think SamClem's idea was a good one. If you are incurring greater risk of physical harm, then why wouldn't that be the right spot for the kind of thing Sam referred to?

Individual Insurance status is protected by HIPAA. An individual would have to volunteer that information.

There are definitely some things that could be changed in HIPAA, but I think all that is really necessary is allowing the imposition of the requirement to present proof of insurance, and allowing denial of service if that's refused, if that's not already permitted.

 

[samclem]

Individual Insurance status is protected by HIPAA. An individual would have to volunteer that information.

Folks with insurance would want it publicized (in this construct) anyway, so they'd give permission for their entry into the database when they sign up. It's a plus for them under any condition I can envision. If they don't want it publicized I suppose they could decline (and pay the higher mortgage rates, car insurance, etc). All that needs to be changed is to allow this information to be used by entities in making their own decisions about a person's creditworthiness, etc.

We're not talking about publicizing whether a person has an STD or a heart murmur, we're talking about making public a bit of financial information. Just like whether an individual has automobile liability coverage.

And, HIPAA is a law, it can be changed.

 

[ziggy29]

If I understand this correctly and I have read this on more than one occassion, when it gets down to it, there is no penalty. I have been told here that Mass. does it differently, but for the federal program, the only means of collection is through withholding tax refunds and that is the sole means. Adjust your withholding correctly, and the fine will never be collected.

This is semantics. It increases your tax liability by the amount of the "penalty." Sure, if you have enough withheld to cover it you're done paying it, but the point is that one way or another you pay it. And it's still a lot cheaper than buying health insurance, so if you are young, healthy and feeling invincible...