Patient Protection and Affordable Care Act

[Sue J]

I'm very happy that this was upheld. I'm looking at this personally because I'm losing my health care coverage on 1-1-14.

DH is retired from public employment. Our health care coverage comes from his pension plan. He gets a very generous allowance based on his years of service and I get a smaller amount also based on his years of service. There are 3 levels of coverage and we chose the lowest cost/lowest coverage option.

When he lost his job in 2010 and we looked into the option of retiring, health care coverage was, of course, a major issue. I had researched the health care coverage and we asked specific questions when we met with the counselor. We knew that the health care coverage was not mandated or guaranteed but they had been providing it since 1962 and they intend to continue to provide it. We fully expected the cost to go up and the coverage to go down. No problem, we can absorb that. In fact, we planned for it.

Soon after DH retired the subsidy for spouses under 55 was eliminated, though a spouse could still be covered and pay the full amount, $615-$807/mo. I was already over 55 so that didn't affect us.

In April 2012 it was announced that health care coverage needed to change. The money comes from a portion of the employer contribution side (not the employee contribution side, that all goes to the pension) and the earnings off of the investments from that portion. Between low investment return, huge increases in health care costs, more people retiring early due to the recession and reduced employment in public jobs they are projecting that they can no longer afford to provide health care insurance for spouses. Many of us have asked if we could have access to coverage and just pay the full premiums ourselves and the answer is NO. This is the largest pension plan in Ohio, over 185,000 retirees (plus spouses). You'd think they could include spouses get a good group rate!

The pension system provides a blog where they post articles and updates and a moderator will answer most of the questions. People are shocked and angry over losing spousal coverage. The pension system is holding Town Hall meetings around the state and you can find the presentations online. They say that they are still considering options but I think they have already decided and that it's a done deal.

It's a matter of income vs outgo. They want to protect the health care benefits for the retiree who worked and paid into the system and at this point they cannot continue to cover spouses. I am a very practical LBYM person so I get it! It's just hard to accept that my DH will be covered and I am eliminated/dropped/left to fend for myself for something as important and EXPENSIVE as health care insurance. All my adult life DH and I had health care coverage through an employer, either mine or his. We've never been in the position of one of us being excluded from coverage.

My part-time job doesn't have any benefits except a "mini-medical" plan that is worthless. It covers 2 office visits and up to $1500 in claims per year. That's useless for any kind of illness.

So I know there will be folks who think the PPAC is evil and socialist and that it will be the beginning of the end for our country. I can't judge the impact. I'm just one little spouse who is being dumped off a cliff in about 18 months. I'm glad this is upheld and I hope it all works out to be a positive change for the country.

If you are interested in the issue of a state pension plan eliminating coverage for spouses, the plan is Ohio Public Employees Retirement System and 2 of the topics on the blog where they are discussing the changes to the health care plan are here -
Health care plan details to be decided this fall | PERSpective
OPERS details potential changes to health care | PERSpective

[M Paquette]

It's a relief for me, as I don't have to worry about recission for something I might have missed on the application, and I'll have guaranteed renewal on January 1, 2013, as the ACA is unlikely to be repealed before then. (I worry about cr*p like this: http://edition.cnn.com/2009/POLITICS....care.hearing/ )

A new state law (currently being challenged in the court, of course) will ban recission for accidental omissions in applications, restricting it to fraud or "intent to deceive" and requiring approval of the state insurance commission, will be in effect before ACA could be repealed.

So, it looks like I'll have individual coverage for myself and my family through 2013. I guess that makes me a socialist, since insurance is just spreading risk and expense over a pool of strangers.

[ziggy29]

Quote:

Originally Posted by Sue J My part-time job doesn't have any benefits except a "mini-medical" plan that is worthless. It covers 2 office visits and up to $1500 in claims per year. That's useless for any kind of illness.

In fact, that's the exact *opposite* of what insurance is supposed to be. Insurance generally covers you against huge, financially devastating losses while expecting you to "self-insure" a modest amount (the deductible). What you have is exactly the opposite -- covers the first small amount of loss, then leaves you exposed to unlimited financial devastation.

[eytonxav]

I'd be a lot more supportive of the law if it was mandatory for all, without all the union/state/law maker exceptions.

Also, the so called coverage of kids up to 26 under their parents plan is not universal either as it does not apply if your parent happens to be covered under a retiree health plan vs an active employee plan (unless your former company does so out of the goodness of its heart).

[Sue J]

Quote:

Originally Posted by ziggy29 In fact, that's the exact *opposite* of what insurance is supposed to be. Insurance generally covers you against huge, financially devastating losses while expecting you to "self-insure" a modest amount (the deductible). What you have is exactly the opposite -- covers the first small amount of loss, then leaves you exposed to unlimited financial devastation.

Yeah, I don't think anybody buys the mini-medical. It's just a way for an employer to say they offer "health care coverage". It doesn't cost the employer anything as the full premium is paid by the employee. This was offered to me by H&R Block and also Live Nation for part -time employees.

[FinanceDude]

It will help certain groups of people. It WILL raise premiums substantially for all. As long as the taxpayers as a group are ok with that, there will be no major upswell to undo any of it.

If anyone can SHOW me how this lowers the national debt or spending I am all ears.........

[ziggy29]

A "hospital only" policy would not meet the requirements because it presumably would not include "first collar" coverage of preventative care which is to be mandatory as of 1/1/2014.

[Mulligan]

Quote:

Originally Posted by MichaelB If your premiums now are large group with employer subsidy or individual with underwriting, it may be painful. OTOH if your premiums are small group unsubsidized they will not likely increase due to the PPACA.

I locked in my individual HI plan before the act went into effect. Since my policy is not under its domain, I assume that this ruling has little effect concerning my future premiums?

[pb4uski]

Quote:

Originally Posted by Mulligan I locked in my individual HI plan before the act went into effect. Since my policy is not under its domain, I assume that this ruling has little effect concerning my future premiums?

Sounds like wishful thinking to me. I think the reality will be that almost all health insurance premiums will go up and I hope I am totally wrong.

[MichaelB]

Quote:

Originally Posted by FinanceDude It will help certain groups of people. It WILL raise premiums substantially for all. As long as the taxpayers as a group are ok with that, there will be no major upswell to undo any of it. If anyone can SHOW me how this lowers the national debt or spending I am all ears.........

If you have any hard data or analysis to support the conclusion that all premiums will rise I would appreciate a link. So far I haven't seen any, and have looked.

Regarding your other point, let's keep the thread focused on health care.

[FinanceDude]

Quote:

Originally Posted by MichaelB If you have any hard data or analysis to support the conclusion that all premiums will rise I would appreciate a link. So far I haven't seen any, and have looked. Regarding your other point, let's keep the thread focused on health care.

I don't see how this ruling will make for better health care in the US. Young people, who are for the most part healthy, would no doubt rather pay a 1% penalty (tax) if they make $30,000 a year, let's say, than pay $250 a month for healthcare. So, the pool of healthy people will shrink, and the pool of unhealthy people will rise dramatically. If you have fewer people paying in overall, the cost burden will fall on fewer people, and costs will rise. That's simple logic.

It WILL help uninsured people get coverage. One could argue they already get covered at literally every ER in the country, as noone is refused medical help, but that's another issue. It will help folks who want to retire early like those on this forum, because it removes the gap between ER and Medicare eligibility. The SCOTUS has ruled this is a TAX, so I am calling it so.........

[Mulligan]

Quote:

Originally Posted by pb4uski Sounds like wishful thinking to me. I think the reality will be that almost all health insurance premiums will go up and I hope I am totally wrong.

I have been fortunate that my premium has not went up in the 2 years I have had it. I played around with a link from a previous poster. I looked at current individual plans and saw that each plan had a rejection rate of 35% - 51% in my state. I also noticed the premium quotes are over double what I am paying for the same plan that was bought prior to the passage of the healthcare act. No wonder my insurance is so relatively cheap in my state as the companies are rejecting a high percentage of applicants.

[ziggy29]

Quote:

Originally Posted by Mulligan No wonder my insurance is so relatively cheap in my state as the companies are rejecting a high percentage of applicants.

Hope they enjoy their last 18 months of being allowed to do so...

Quote:

Originally Posted by REWahoo The Obamacare term once had a distinct negative connotation but it has been used so much to refer to the PPACA that it is now commonplace. I no longer think of it being improper any more than using the term Xerox for copying or Kleenex for tissue....

This.

[Midpack]

Quote:

Originally Posted by MichaelB If you have any hard data or analysis to support the conclusion that all premiums will rise I would appreciate a link. So far I haven't seen any, and have looked.

A big part of the problem is no one seems to have much in the way of hard facts, at least that I can find/comprehend. I wish I could find any reassurance that premiums won't increase significantly.

It was asked earlier, but how will PPACA prevent free-riders among people who can (well) afford to pay for health insurance, given guaranteed issue? I've read that state(s) have gotten into this fix already, MA among them? The penalties are small relative to current premiums, which will give employers and individuals an incentive to pay penalties until they need HI, then enroll. And then drop coverage and resume penalties again. Does GI enable this?

I've tried to answer my own question via Google, but come up mostly empty so far. FWIW Game On! How guaranteed issue coverage and PPACA will cause employers and individuals to cancel their coverage, and join the ranks of the uninsured. - I don't know anything about this organization, but I've read about the potential issue from other sources.

[ziggy29]

Quote:

Originally Posted by Midpack It was asked earlier, but how will PPACA prevent free-riders among people who can (well) afford to pay for health insurance, given guaranteed issue? I've read that state(s) have gotten into this fix already, MA among them? The penalties are small relative to current premiums, which will give employers and individuals an incentive to pay penalties until they need HI, then enroll. And then drop coverage and resume penalties again. Does GI enable this?

I've long said that if there is a penalty for "going naked", it should be (at minimum) equal to the cost of the lowest-priced qualifying policy available. That would eliminate all incentive to do without.

I have heard that Massachusetts is (or was) having a problem in that (a) more low-income people were rushing to sign up than they anticipated and (b) the penalties weren't enough to stop the young and healthy from "paying the penalty" instead of buying insurance.

[Mulligan]

Quote:

Originally Posted by Midpack A big part of the problem is no one seems to have much in the way of hard facts, at least that I can find/comprehend. It was asked earlier, but how will PPACA prevent free-riders among people who can (well) afford to pay for health insurance, given guaranteed issue? I've read that state(s) have gotten into this fix already, MA among them? I've tried to answer my own question via Google, but come up mostly empty so far. FWIW Game On! How guaranteed issue coverage and PPACA will cause employers and individuals to cancel their coverage, and join the ranks of the uninsured. - I don't know anything about this organization, but I've read about the potential issue from other sources.

I guess I am an exception to the rule. Looking at the link, my premium cost is actually cheaper than paying the penalty of 1% coming soon and obviously less than the future 2% penalty for not buying it. So I would currently have no incentive to pay the penalty and forgo insurance.

[Midpack]

Scares me, note #3, 6 & 7...

Quote:

There has been a lot in the national press about how health care reform in Massachusetts has worked.* There's a lot of blather on both sides of the political spectrum, and the Boston Globe*had a comprehensive article today reviewing how “RomneyCare” is working here.* Conclusions: 1) Far more people are insured than before health care reform, despite the disastrous recession (98.1%) 2) More employers (up from 70 to 76%) are offering insurance, again despite the recession 3) The exchanges work for individuals - they haven't worked well for small employers yet 4) The cost of the care of the uninsured has declined. 5) There is inadequate primary care access, and ED visits have gone up rather than down. 6) The cost has been manageable - but the state has relied on some payments from the feds (stimulus dollars and Medicaid add-on dollars) that will not continue. The federal government has paid a disproportionate share of the total cost (as it will under the Affordable Care Act). 7) Health care reform promised incremental provider Medicaid payments that have not been funded. Hospitals say they must pass these costs on to other payers, which worries employers greatly. 8) Health care reform is actually pretty popular in Massachusetts.* The last Harvard School of Public Health poll said that 63% of residents support health care reform.*

[huusom]

Quote:

Originally Posted by ziggy29 Or, if you have the money for COBRA, many folks can start a countdown to July 2012, 18 months out from the implementation of most provisions of the act -- T-minus three days....

I would love to but I like add a little more to my 401K before I pull the switch.

[ziggy29]

Quote:

Originally Posted by Mulligan I guess I am an exception to the rule. Looking at the link, my premium cost is actually cheaper than paying the penalty of 1% coming soon and obviously less than the future 2% penalty for not buying it. So I would currently have no incentive to pay the penalty and forgo insurance.

Are you referring to the full, unsubsidized cost of this insurance or just your portion under cost-sharing? For example, I pay a little more than 20% of the full unsubsidized cost of my policy. That comes to about 1.5% of my income. But if I look at the unsubsidized cost, it would be closer to 7%.

[pb4uski]

Agree ziggy. My health insurance premiums today are much higher than the penalty would be.

Perhaps I should plan to game the system and drop health insurance on 1/1/2014, pay the penalty and then buy guaranteed issued insurance if I have a health event. I think the way it works that I would only be screwed if I had such an immediate health event that I couldn't get the time to buy the insurance (like a heart attack requiring immediate surgery).