Potential Changes to PPACA

[truenorth418]

Here is something to look out for in the upcoming "fiscal cliff" discussions. There could be changes coming to the insurance subsidies.

Federal Deficit Talks Could Impact Obama

 

[Midpack]

At this point, everything must be on the table for the "arithmetic" to work...no way around it. Funny to see that old word used so much lately...

 

[pb4uski]

It is interesting to me that I have seen very little talk about fixing the cliff of subsidies from ~10% at 400% FPL to 0% @ 401% APL

 

[samclem]

It is interesting to me that I have seen very little talk about fixing the cliff of subsidies from ~10% at 400% FPL to 0% @ 401% APL

I think folks on this site generally have a more thorough understanding of the law than the general public. Many of us have looked at the impact of the sharp subsidy cutoff, and are already thinking about how to adapt to that environment (lumping income into alternate years, etc). There's no general push for changes yet because the problems with the the law haven't yet become apparent to many people. And seeing/reacting to any problems with health care delivery itself (e.g. stemming from higher demand for medical care, but fewer providers due to changed incentives, etc) will become apparent only even farther down the road.

Interesting times. We'll get what we deserve (collectively, not individually, which is always a probem).

 

[ERhoosier]

I actually read the entire PPACA (955 pages as amended), and cost is but one major consideration. There is much regarding actual implementation that is not precisely defined & will eventually depend on administrative fiat. Vast potential for various "exemptions", "extensions", etc. being granted---or not. To the individual US citizen, PPACA seems like it will remain a work in progress for years to come.

 

[youbet]

Interesting times. We'll get what we deserve (collectively, not individually, which is always a probem).

That's scary stuff! Makes me fear for my family.

 

[Mulligan]

I read an interesting opinion from a person in another forum that I hadn't thought about. He suggested it is possible the new health exchanges could help people who currently have grandfathered high deductible plans. Since most of these are underwritten, the people in the group are relatively healthy. Ones in the group who develop health problems in these plans will leave them to join the exchange plans which have lower deductibles. This leaves the healthier ones behind in the high deductible plan keeping the premiums lower since costs of the group is lower.

 

[samclem]

This leaves the healthier ones behind in the high deductible plan keeping the premiums lower since costs of the group is lower.

That's an interesting idea, things might just work out that way. Much will probably depend on the availability and quality of care available in the exchanges. The sick folks might just stay in the HD plan if it means they can actually get in to see a doctor (and one they like) and have fewer restrictions on treatment protocols.

 

[pb4uski]

I actually read the entire PPACA (955 pages as amended)....

No disrespect, but that is sad.

 

[JoeWras]

No disrespect, but that is sad.

Hey, there's another recent discussion on these boards asking "what will you do when retired".

This sounds like a fun way to spend that time.

 

[ERD50]

I read an interesting opinion from a person in another forum that I hadn't thought about. He suggested it is possible the new health exchanges could help people who currently have grandfathered high deductible plans. ...

I follow the logic - seems reasonable. But that does need to be a grandfathered high deductible plan, right? As I understand it, High Deductible plans are not allowed under the new plan? Unfortunate if true, all my other insurance is high deductible, but I don't have that option under my MegaCorp retiree plan - other than leave it.

-ERD50

 

[MichaelB]

I follow the logic - seems reasonable. But that does need to be a grandfathered high deductible plan, right? As I understand it, High Deductible plans are not allowed under the new plan? Unfortunate if true, all my other insurance is high deductible, but I don't have that option under my MegaCorp retiree plan - other than leave it.

-ERD50

I have not seen any mention of high deductible plan exclusion under the PPACA. Do you have a source for that? I'd be very interested in reading the details.

 

[ERD50]

I have not seen any mention of high deductible plan exclusion under the PPACA. Do you have a source for that? I'd be very interested in reading the details.

No specific source, I'd have to do some googling. I thought I had heard that they don't qualify, but I could very well be mistaken. I had also figured that is why he used the term 'grandfathered' in his post?

My current Mega Corp plan is not high-deductible, so I could not be grandfathered in.

-ERD50

 

[MichaelB]

OK, thanks. My understanding is any plan is acceptable as long as it meets certain coverage standards. I too hope HSA plans continue, the tax benefit is nice to have.

 

[meierlde]

OK, thanks. My understanding is any plan is acceptable as long as it meets certain coverage standards. I too hope HSA plans continue, the tax benefit is nice to have.

Now what if instead of an HSA all health insurance premiums become taxable, which would wipe out the exclusion on the employer payment as well as benefit cost reduction plans where the employee contribution is made pretax, as well as hsas all at one pop.

 

[Mulligan]

No specific source, I'd have to do some googling. I thought I had heard that they don't qualify, but I could very well be mistaken. I had also figured that is why he used the term 'grandfathered' in his post?

My current Mega Corp plan is not high-deductible, so I could not be grandfathered in.

-ERD50

Yes, that is what I was referring too was the grandfathered individual plans. I also think, like you said that the new plans will not be high deductible in at least the range that we presently perceive them as.

 

[ERD50]

OK, thanks. My understanding is any plan is acceptable as long as it meets certain coverage standards. I too hope HSA plans continue, the tax benefit is nice to have.

Well a little googling seems to confirm my original understanding:

from forbes:

Another Broken Obama Promise: The Healthcare Cost Monster Emerges - Forbes

Unfortunately, Obamacare is trying to halt this cost-control effort by imposing crippling restrictions on high-deductible plans.

For example, the law bans deductibles over $2,000 for single coverage. As a result, 14 percent of all workers — and 27 percent of those in small firms — will end up paying more for coverage after they’re forced into a government-approved plan.

Maybe there is more to the story,b ut that's all the googling I got to before dinner-time.

-ERD50

 

[Mulligan]

Well a little googling seems to confirm my original understanding:

from forbes:

Another Broken Obama Promise: The Healthcare Cost Monster Emerges - Forbes

Maybe there is more to the story,b ut that's all the googling I got to before dinner-time.

-ERD50

Unfortunately, it makes sense. In order to help keep premiums down for the rest, they want the healthy people paying for lower deductible higher premiums. As of now, my HSA tax deduction pays for my entire yearly premium with a little left over for my $5500 deductible. I certainly hope they don't close this plan down, as I undoubtably would pay considerably more in an exchange based plan.

 

[ERhoosier]

No disrespect, but that is sad.

Actually there's much less actual verbiage than a 955 page book. Most is in outline format.
With so much mis/dis-information out there (inc from the 'ethical' press) it just seemed logical to consult the real document itself.

 

[marko]

Unfortunately, it makes sense. In order to help keep premiums down for the rest, they want the healthy people paying for lower deductible higher premiums. .

Won't higher premiums be really, really good for insurance companies? I doubt the actuaries won't figure out a profitable pricing strategy on lower deductibles.

Sounds like a license to steal.

 

[MichaelB]

Here is a link that focuses on the analysis and not the politics. http://www.ifebp.org/inforequest/0160537.pdf

High deductible plans and HSA are still allowed. Small group plans have a maximum deductible of $2K per individual. Don't know about individual or large group plans.

No one knows if prices for those plans will rise or not, especially magazine writers with an agenda.

 

[gerrym51]

this is modeled on ma. plan no deductible higher than 2400 allowed in mass.

if you were hoping for a really high deductible plan says 10,000 you won't get it

 

[pb4uski]

Won't higher premiums be really, really good for insurance companies? I doubt the actuaries won't figure out a profitable pricing strategy on lower deductibles.

Sounds like a license to steal.

IMO, it depends because the cause of the higher premiums is higher risk and claims because of pre-existing conditions, etc. If they price it right it could be good, but the transparency of the exchanges should put pressure on pricing so the end result will largely depend on whether some companies decide to price really competitively in order to gain market share.

I think there is a reasonable possibility that the exchanges could become a war zone and the insurers will beat the stuffing out of each other price-wise, which would be bad for the insurers.

 

[easysurfer]

Too early to compare the costs vs HSAs. Would be nice when the time comes to compare what's a better deal financially, a plan under PPACA or HSA for one that socks away the contributions and doesn't withdraw or HSA for one the withdraws each year as reimbursement or qualified expenses.

Looks like I'm waiting for the App to arrive. Maybe then I'll finally get a smartphone

 

[gerrym51]

i am going to retire early. my cobra price is less than the mass connector plans.
i live in mass. cobra is not cheap


remember under this system an insurance company cannot turn you down.

the prices will not be cheap like some imagine.

i posted on another thread.

google mass. health care connector. select non subsidised plans.

will ask age and zip code. google a mass zip code and enter it.

this system guarantees coverage. it does nothing to control costs