Obamacare

[MichaelB]

I'm not sure. All I know is that the HSA threshold (which is used as the cost-sharing limit for ACA) changes year to year.

Neither, as I just found out. Again, from KFF

Generally, the limits are based on the maximum out-of-pocket limits for Health Savings Account-qualified health plans ($5,950 for single coverage and $11,900 for family coverage in 2010), which will be indexed to the change in the Consumer Price Index until 2014 when the provision takes effect.6 After 2014, the limits will be indexed to the change in the cost of health insurance

http://www.kff.org/healthreform/upload/7962-02.pdf

 

[Texas Proud]

You can review the twenty-some pages of this thread for examples.

I'm mystified as to why some people seem to be pleased that there are "losers" in the new plan. What satisfaction are they getting from it? Is it because Obamacare was a political battle and, now won, must extract some blood from the losers for the delight of the "winners?"

Edit: I'm now seeing the mod warning above posted while I was typing. I'll exit this discussion.

I don't see that people are glad that there are losers at all... I do see where some are happy that the system has changed and that more people will be covered by insurance... but even the ones that like the law do not seem to be gloating about losers...

I do see where the facts are coming out and people say that is the way it is.... and they are right... no malice IMO...

I am kinda in the middle about the law (however, I would rather it not have passed, but it did and it is the law).... I do think there are a lot of good things in the law, my biggest beef is that the gvmt is going to be spending $100 billion a year more than before... that money comes from somewhere... and I believe that without some kind of real structural change in the costs of the system, the costs are going to continue to skyrocket and make our debt worse than it already is.....

 

[travelover]

......... and I believe that without some kind of real structural change in the costs of the system, the costs are going to continue to skyrocket and make our debt worse than it already is.....

Bingo. As Warren Buffet says, trees don't grow to the sky. Equilibrium will be reached either by Americans being bled dry or more radical reform implemented to bring us into synch with other Western nations in terms of cost / outcome.

 

[ziggy29]

Haven't seen if posted elsewhere but HHS just released the application that a single individual will need to apply for the exchange and the subsidy process. Article on it is here:

HHS releases form to apply for Obamacare coverage - May. 1, 2013

 

[Northwoods Mary]

This is my first posting here - I just joined your group yesterday - but I have taken the time to read the entire thread and find it to be the most comprehensive discussion I've found online. Thanks to all of you for the comments and resources!

As my husband and I plan for our ER (once our house which could take awhile), what to do about health coverage has been one of our major worries. DH stayed with a megacorp for over twenty years because one of the benefits was going to be subsidized retiree insurance if he left anytime after 55, at the same cost as when working. Just before he qualified, megacorp #1 sold to megacorp #2; inspite of promises to the contrary during the transition, it now looks as though retiree coverage under #2 will be much more expensive, and would limit us to choosing one healthcare provider, which won't work for us since we'll be traveling.

So unlike others who have posted here, we HOPE the retiree coverage will be dropped so it doesn't prevent us from using the exchange (still investigating the details on that but it looks like it would be about a quarter the cost of the employer coverage). Until full retirement age, I believe we will be able to stay under the 400% cap by using interest/dividends much less than $60,000 and after tax dollars; once we are eligible for Medicare, supplemental plans are much cheaper, even if we are living on before tax IRA income at that point. We hope the exchange eventually also will offer reasonable LTC plans, and dental too. (Although we know many who get great, reasonable dental care in Canada or Mexico, provided it is not an emergency.)

A couple of additional observations to comments discussed here: high deductible plans are by far the most profitable for insurance companies, which is why they like them (on a premiums collected vs. payments made basis). The HSA tax savings that insurers receive do reduce the cost to the insured, but this is a government/taxpayer subsidy, just as the Affordable Care Act provides subsidies. High deductible plans, then, are cheaper because the insured is receiving less of a benefit and because of the tax subsidy. Also as mentioned here, some purchased these plans because it was all they could afford, going without needed preventive care, etc. and still at times being forced into bankruptcy. Uncompensated care (absorbed by providers but then cost shifted to the rest of us) grew dramatically with the advent of high deductible plans, because patients couldn't afford to pay for the care beneath the deductible limit. So (if I recall correctly) as a matter of public policy, if subsidies were going to be used (whether via HSAs or PPAACA subsidies) the idea was to try to get the most bang for the tax payer buck in terms of money spent actually paying for care. (Let me know if I'm too far off thread).

I will be following this forum closely for as much information as we can glean about how this will work, in the event we are fortunate enough to sell our home soon and have to decide whether to pull the plug before the ACA is implemented. If we do decline the retiree insurance, there will be no going back later.

 

[Malcolm2]

Very well done article in the WSJ yesterday April 30. Documents the huge increases in premiums apparently imminent. They estimate damage to 30-40 million people caused by increases and employment cutbacks!! Premiums expected to rise for 30 percent of us alone. Article was written by Daniel Kessler a Professor at Stanford.

Daniel Kessler: The Coming ObamaCare Shock - WSJ.com

 

[Texas Proud]

This is my first posting here - I just joined your group yesterday - but I have taken the time to read the entire thread and find it to be the most comprehensive discussion I've found online. Thanks to all of you for the comments and resources!

As my husband and I plan for our ER (once our house which could take awhile), what to do about health coverage has been one of our major worries. DH stayed with a megacorp for over twenty years because one of the benefits was going to be subsidized retiree insurance if he left anytime after 55, at the same cost as when working. Just before he qualified, megacorp #1 sold to megacorp #2; inspite of promises to the contrary during the transition, it now looks as though retiree coverage under #2 will be much more expensive, and would limit us to choosing one healthcare provider, which won't work for us since we'll be traveling.

So unlike others who have posted here, we HOPE the retiree coverage will be dropped so it doesn't prevent us from using the exchange (still investigating the details on that but it looks like it would be about a quarter the cost of the employer coverage). Until full retirement age, I believe we will be able to stay under the 400% cap by using interest/dividends much less than $60,000 and after tax dollars; once we are eligible for Medicare, supplemental plans are much cheaper, even if we are living on before tax IRA income at that point. We hope the exchange eventually also will offer reasonable LTC plans, and dental too. (Although we know many who get great, reasonable dental care in Canada or Mexico, provided it is not an emergency.)

A couple of additional observations to comments discussed here: high deductible plans are by far the most profitable for insurance companies, which is why they like them (on a premiums collected vs. payments made basis). The HSA tax savings that insurers receive do reduce the cost to the insured, but this is a government/taxpayer subsidy, just as the Affordable Care Act provides subsidies. High deductible plans, then, are cheaper because the insured is receiving less of a benefit and because of the tax subsidy. Also as mentioned here, some purchased these plans because it was all they could afford, going without needed preventive care, etc. and still at times being forced into bankruptcy. Uncompensated care (absorbed by providers but then cost shifted to the rest of us) grew dramatically with the advent of high deductible plans, because patients couldn't afford to pay for the care beneath the deductible limit. So (if I recall correctly) as a matter of public policy, if subsidies were going to be used (whether via HSAs or PPAACA subsidies) the idea was to try to get the most bang for the tax payer buck in terms of money spent actually paying for care. (Let me know if I'm too far off thread).

I will be following this forum closely for as much information as we can glean about how this will work, in the event we are fortunate enough to sell our home soon and have to decide whether to pull the plug before the ACA is implemented. If we do decline the retiree insurance, there will be no going back later.

I have nothing to back it up, but I would bet that having health coverage offered to ex-employees does not come into the picture.... heck, you no longer are employed....


My mega had the same kind of coverage... when there was a merger, they decided to stop offering it for future retirees.... but did have the cut off age of 50 to qualify (could not sign up until 55)... I was 49 at the time...

 

[Northwoods Mary]

Actually, I think there is something about this (retiree coverege) in the ACA. Don't quote me, but I think it has to do with whether the employer is paying at least 50% of the cost of the policy, and whether it is considered "affordable" as a percentage of you income. I don't think everyone (retired or not) to just opt out of an employee-paid plan and go to the exchange for coverage. Our problem is that we can't get much specific information from the megacorp - seems like they don't want to commit to anything. So it's hard to know where we will be.

 

[travelover]

Very well done article in the WSJ yesterday April 30. Documents the huge increases in premiums apparently imminent. They estimate damage to 30-40 million people caused by increases and employment cutbacks!! Premiums expected to rise for 30 percent of us alone. Article was written by Daniel Kessler a Professor at Stanford.

Daniel Kessler: The Coming ObamaCare Shock - WSJ.com

Funny, this appears to me as an opinion piece, not a "news" article. And it is from a newspaper owned by Rupert Murdock, famous for his impartiality - especially regarding Fox News network.

 

[Birdie Num Nums]

Funny, this appears to me as an opinion piece, not a "news" article. And it is from a newspaper owned by Rupert Murdock, famous for his impartiality - especially regarding Fox News network.

And Daniel Kessler seems to have an agenda himself, if his previous articles are any indication.

 

[rbmrtn]

Actually, I think there is something about this (retiree coverege) in the ACA. Don't quote me, but I think it has to do with whether the employer is paying at least 50% of the cost of the policy, and whether it is considered "affordable" as a percentage of you income. I don't think everyone (retired or not) to just opt out of an employee-paid plan and go to the exchange for coverage. Our problem is that we can't get much specific information from the megacorp - seems like they don't want to commit to anything. So it's hard to know where we will be.

There is a flowchart here from Kaiser that may help. Question maybe if a retiree plan is considered an employer plan since you are not actually employed. From the flow chart, you can choose the employer plan or the exchange plan. The amount covered by the employer determines if the subsidies are available.

How People Get Coverage Under the Affordable Care Act - Kaiser Health Reform

 

[M Paquette]

Very well done article in the WSJ yesterday April 30. Documents the huge increases in premiums apparently imminent. They estimate damage to 30-40 million people caused by increases and employment cutbacks!! Premiums expected to rise for 30 percent of us alone. Article was written by Daniel Kessler a Professor at Stanford.

Daniel Kessler: The Coming ObamaCare Shock - WSJ.com

Please note that this is an editorial piece from the Opinion section of the paper. Use Google to reference other works by Daniel Kessler, and you may see a certain bias. May or may not be a kindred spirit, but he does seem to be grinding an axe of some form.

The editorial does mention that some 6 million out of 19 million on individual insurance will see premium increases. Note that that leaves 13 million on individual insurance with premiums unchanged or decreasing. This is roughly what I would expect from the clauses in the PPACA law that narrow the range of premiums to the highest being 3X the rate for the lowest for any given policy. Extremely low priced policies, such as my daughter's high deductible HSA eligible plan will become more expensive for her age group. The huge percentage hike corresponds to a rise in price of about $60/month (before subsidies).

 

[meierlde]

Please note that this is an editorial piece from the Opinion section of the paper. Use Google to reference other works by Daniel Kessler, and you may see a certain bias. May or may not be a kindred spirit, but he does seem to be grinding an axe of some form.

The editorial does mention that some 6 million out of 19 million on individual insurance will see premium increases. Note that that leaves 13 million on individual insurance with premiums unchanged or decreasing. This is roughly what I would expect from the clauses in the PPACA law that narrow the range of premiums to the highest being 3X the rate for the lowest for any given policy. Extremely low priced policies, such as my daughter's high deductible HSA eligible plan will become more expensive for her age group. The huge percentage hike corresponds to a rise in price of about $60/month (before subsidies).

So for the sake of argument only assume that the median premium remained the same, then 40% would see an increase 40% a decrease and the middle would stay the same.
Now its likley the curve will be shifted somewhat to the higher cost side, as more things are covered than under older policies, such as preventative tests, which can run 3k on up for some, as well as other extensions.So to be a concern one would have to say that the median premium went up, as in any simple re-shuffle there will be a bell curve of those affected.

 

[ERhoosier]

Funny, this appears to me as an opinion piece, not a "news" article. And it is from a newspaper owned by Rupert Murdock, famous for his impartiality - especially regarding Fox News network.

While I fully agree that Mr.Kessler's piece is editorial content (and was presented as such by WSJ), attacking the publication & owner/publisher is not a logically valid argument against Kessler's thesis. Until actual 2014 premiums (and employment data) are published, all writings on this point remain opinion/speculation.

 

[bUU]

Until actual 2014 premiums (and employment data) are published, all writings on this point remain opinion/speculation.

Including Kessler's.

What does seem likely is that many states have so poorly funded their efforts to ramp up for ACA that they've created a catastrophe-in-waiting through their penny-wise/pound-foolish approach.

By comparison, the "harm" of upgrading from what is arguably inadequate insurance to what is compliant insurance is a nitpick.

 

[Malcolm2]

While I fully agree that Mr.Kessler's piece is editorial content (and was presented as such by WSJ), attacking the publication & owner/publisher is not a logically valid argument against Kessler's thesis. Until actual 2014 premiums (and employment data) are published, all writings on this point remain opinion/speculation.

The article has many interesting facts. Lets stick to the facts shall we. I have recently priced a policy for myself and family. It would be $18K. I suppose I would be one of the 35 percent. Attacking a publication when you do not agree with the facts is a very weak way to go. If there are other facts, lets see them.

 

[MichaelB]

Until actual 2014 premiums (and employment data) are published, all writings on this point remain opinion/speculation.

There is plenty of hard data, certainly enough to make credible comparisons and present informed analysis. Estimates of premium prices, however, need to include basic elements such as levels of coverage, actuarial value and cost sharing. Otherwise the numbers used (and conclusions) have little meaning. The data is out there and available today, but it's not being used. That's why I look at sources such as KFF.

 

[pb4uski]

.....What does seem likely is that many states have so poorly funded their efforts to ramp up for ACA that they've created a catastrophe-in-waiting through their penny-wise/pound-foolish approach. ....

And what seems equally likely to me is that there are a bunch of chicken littles screaming that the sky is falling and that while there will be the inevitable bumps associated with significant change that it will not be the disaster that some believe. (and I've never been a big fan of ACA to begin with).

 

[bUU]

I agree that there are inevitable bumps associated with significant change, but please do understand that there are problems brewing that are directly associated to underfunding of or late starting of work toward the introduction of ACA by the states. Some of this has already been made public; other instances have not yet been.

 

[FinanceDude]

There is plenty of hard data, certainly enough to make credible comparisons and present informed analysis. Estimates of premium prices, however, need to include basic elements such as levels of coverage, actuarial value and cost sharing. Otherwise the numbers used (and conclusions) have little meaning. The data is out there and available today, but it's not being used. That's why I look at sources such as KFF.

Except for a couple HUGE factors, like the exchanges are not set up yet, and the insurers who will be involved in those exchanges have not released their remium rates yet. However, most of the big insurers have increased premiums 15-25% THIS year, no doubt in expectation of the implementation of Obamacare. The guidelines in the link are from JUly 2012. Most of the regulations have not yet been written, something I have heard little about. If one listens to the rhetoric coming out of Washington, there will be big changes coming..........

 

[FinanceDude]

What does seem likely is that many states have so poorly funded their efforts to ramp up for ACA that they've created a catastrophe-in-waiting through their penny-wise/pound-foolish approach.

And those states were right to do so. The federal govt would like nothing more than to have the states shoulder the implementation of Obamacare. Why set up a state run exchange, only to have the feds reduce the funds in the future, which they are notorious for doing based on past experience?

By comparison, the "harm" of upgrading from what is arguably inadequate insurance to what is compliant insurance is a nitpick.

It's not nitpick when we all will be paying a lot more for health insurance.........

 

[MichaelB]

Except for a couple HUGE factors, like the exchanges are not set up yet, and the insurers who will be involved in those exchanges have not released their remium rates yet. However, most of the big insurers have increased premiums 15-25% THIS year, no doubt in expectation of the implementation of Obamacare. The guidelines in the link are from JUly 2012. Most of the regulations have not yet been written, something I have heard little about. If one listens to the rhetoric coming out of Washington, there will be big changes coming..........

My point was, and is, that there is sufficient data about rates to make meaningful and useful comparisons. Absent hard data and with no analytics, what appears in the paper, and elsewhere, is really a rant.

Most of the regulations have been written, reviewed, revised, publuished and implemented. The rest were written and published for review and commentary, updated, and final versions being released.

 

[bUU]

Except for a couple HUGE factors, like the exchanges are not set up yet, and the insurers who will be involved in those exchanges have not released their remium rates yet.

Anyone who expected to see these things before the official deadline of October 1 was misled. To be fair, that deadline might not be met in all cases, for the reason I mentioned earlier... that many states that committed to handling their own exchanges have grossly under-resourced the effort.

However, most of the big insurers have increased premiums 15-25% THIS year, no doubt in expectation of the implementation of Obamacare.

You must be using the term "no doubt" in a manner inconsistent with my understanding of its meaning. Our plan is already ACA-complaint - has been for years, even vis a vis the new requirements - and yet come March, our next open enrollment period, I bet we'll have a nice increase, because health care costs go up every year due to inflation.

And those states were right to do so.

What logic is there to commit to do something and then neglect your commitment?

The federal govt would like nothing more than to have the states shoulder the implementation of Obamacare. Why set up a state run exchange, only to have the feds reduce the funds in the future, which they are notorious for doing based on past experience?

The states had the option to dump responsibility for the exchanges onto the federal government.

It's not nitpick when we [on average] will be paying a lot more for [adequate] health insurance [then we were paying for inadequate health insurance] .........

Fixed your comment so it was a reply to the statement it was posted in reply to; unfortunately, that made your comment doesn't have the same significance as compared to when it was responding to something I didn't say.

 

[ziggy29]

There is plenty of hard data, certainly enough to make credible comparisons and present informed analysis. Estimates of premium prices, however, need to include basic elements such as levels of coverage, actuarial value and cost sharing. Otherwise the numbers used (and conclusions) have little meaning. The data is out there and available today, but it's not being used. That's why I look at sources such as KFF.

I do wish the KFF calculator would put up more options than just "single" and "family of 4", though. I think I've figured out how to "read between the lines" and get an estimate for a "family of 2" by figuring out the percentage of income we're expected to pay relative to the poverty line for any given family size, but it's a little bit of a hassle.

 

[MichaelB]

I do wish the KFF calculator would put up more options than just "single" and "family of 4", though. I think I've figured out how to "read between the lines" and get an estimate for a "family of 2" by figuring out the percentage of income we're expected to pay relative to the poverty line for any given family size, but it's a little bit of a hassle.

Have you tried the Berkeley calculator? It has more detail and may provide what you are looking for. National Health Care Calculator