PPACA, Obamacare and General Comments

[rbmrtn]

Quote:

Originally Posted by MichaelB Not sure about the March date, first time I've seen it.

This may be it, from the rules changes of the federal register. ( this brings back memories of dealing with Title 10CFR )

https://www.federalregister.gov/arti...lth-plans#h-95

We have extended the initial open enrollment period by one month—from February 28, 2014 to March 31, 2014. HHS's experience with the initial open enrollment period for Medicare's Prescription Drug Benefit Program supports an extended period. We have not extended the initial open enrollment period past March 31 in order to limit the risk of adverse selection, as expressed by commenters.

[MichaelB]

In addition to the Mass health exchange, October enrollments are already the norm for conversion and very small business guaranteed issue policies in many states. The intent has been discussed often around here, to make it difficult for people to only take insurance when they become ill. Ensuring no lapse in coverage for 63 days has been a fundamental aspect of healthcare insurance for many years, it continues in Mass, so it would not be a surprise to see it as part of the exchange policy.

As for the March date, looking for it I find more references. Mulligan is probably right: half don't know enough, the other half don't know that they don't know, so some extra time is built into the initial rollout.

[Mulligan]

Quote:

Originally Posted by MichaelB In addition to the Mass health exchange, October enrollments are already the norm for conversion and very small business guaranteed issue policies in many states. The intent has been discussed often around here, to make it difficult for people to only take insurance when they become ill. Ensuring no lapse in coverage for 63 days has been a fundamental aspect of healthcare insurance for many years, it continues in Mass, so it would not be a surprise to see it as part of the exchange policy. As for the March date, looking for it I find more references. Mulligan is probably right: half don't know enough, the other half don't know that they don't know, so some extra time is built into the initial rollout.

I know we have always had "sleepwalkers" in our country and it is no different than anywhere else, probably, but it just blows my mind how so many people still don't have a clue it's law. You watch, come the following tax year, almost 3 years after the Act has become law there will be millions filling their taxes and saying this to themselves.." what's this health insurance penalty tax thing? I thought Congress got rid of this law."

[ERhoosier]

Quote:

Originally Posted by rbmrtn They are charged with doing so by the law itself. The secretary is charged with establishing the enrollment periods ( section 1311 (6) Enrollments ). The specific dates aren't in the "law".

Under ACA, SHOP exchanges were to start Jan 2014 per sec 1311. No one appears to be challenging HHS decision to push these back to 2015.

My prev statement re 2013 open enrollment period was poorly worded. Should have been more clear that I was referring to modifying those dates now. While Sec HHS does have latitude in setting open enrollment dates in subsequent years, the dates of "initial open enrollment, as determined by the Secretary" were to be determined "not later than July 1, 2012" (sec 1311 b 6). Prev citation from Fed Register indicates the decision to extend initial open enrollment into March was made just recently. Again, not saying extension of the initial OE period is a bad thing, just that I don't see Sec's authority under ACA to modify the OE dates this late...and doubt that anyone will challenge the decision.

http://www.healthcare.gov/law/full/t...ealth-care.pdf

I agree with prior posts that public is largely clueless re ACA (& HI in general), doubt longer initial OE period will make much difference. Mulligan's prob right that many, many folks are "sleepwalkers" & won't deal with this until forced to.

[travelover]

Quote:

Originally Posted by ERhoosier .......Mulligan's prob right that many, many folks are "sleepwalkers" & won't deal with this until forced to.

Are we talking about the ACA or retirement in general?

[MichaelB]

Quote:

Originally Posted by travelover Are we talking about the ACA or retirement in general?

More like life itself. A real first world problem. The information is there, lots of folks waiting for it to arrive on a platter.

[CH]

Quote:

Originally Posted by ERhoosier Under ACA, SHOP exchanges were to start Jan 2014 per sec 1311. No one appears to be challenging HHS decision to push these back to 2015.

I think the SHOP exchanges only apply to employees. I don't think they would have anything to do with retirees, early or otherwise.

[ERhoosier]

Quote:

Originally Posted by travelover Are we talking about the ACA or retirement in general?

In general. For years comedians like Leno have used these "sleepwalkers" as easy fodder for jokes-

Best of Jaywalking - Video

[cute fuzzy bunny]

Hmm, typed in a long post and e-r.org fell off the internet for a minute! Weird.

Short version: Since I got divorced, I need my own h/c. Got declined from my current provider (kaiser) because a few years ago I was prediabetic and prehypertensive. As any kaiser patient knows, they love giving you lots and lots of pills and you may never get well from any condition. I checked with some other providers, and they doubled their teaser rates on me, and when they pull the full medical history from kaiser they'll probably retroactively decline me as well. Stooopid since they HAVE to take me after 1/1. Considering I'm 169lbs, my bp is 120/72 and my recent a1c test was 5.5, I'm pretty amused that kaiser declined me. I'd actually been considering a slightly lower cost option, but I think I'll stick with them and stick it to them. I'd like ALL kinds of tests run...

So I'll be stuck with kaiser on cobra at around 800-900 a month until 1/1, when I'll get on an individual plan with them. Since I paid off my mortgage, cars and other debt and my 1040 reported income is under the 400% limit, I'll get subsidized care at under $200 a month.

So somebody has to go revise the 'should I pay off the mortgage' threads with a 5-10k reduction in health care costs...

[pb4uski]

What does paying off the mortgage have to do with health care costs? O-MAGI is before any deductions as I recall, so unless you are drawing your mortgage payments from tax-deferred funds it shouldn't matter.

[Mulligan]

Ohio, who was one of the original dozen or so states speculated to be facing "rate shock". Well it appears the original speculation may be true. Of course it all depends upon subsidies, etc. They are estimating an 88% increase based on rates submitted. They are currently under review by the state. The press release below explains it more.

http://www.insurance.ohio.gov/Newsro...osedRates.aspx

[travelover]

Quote:

Originally Posted by Mulligan Ohio, who was one of the original dozen or so states speculated to be facing "rate shock". Well it appears the original speculation may be true. Of course it all depends upon subsidies, etc. They are estimating an 88% increase based on rates submitted. They are currently under review by the state. The press release below explains it more. Ohio Department of Insurance

I wonder why Ohio would be hit harder than any other state. Did the state allow more minimal policies to be sold such that policies meeting minimum ACA standards provide more coverage, but cost more?

[MichaelB]

Quote:

Originally Posted by pb4uski What does paying off the mortgage have to do with health care costs? O-MAGI is before any deductions as I recall, so unless you are drawing your mortgage payments from tax-deferred funds it shouldn't matter.

The point may be that if the mortgage is paid less income is needed to support oneself, and that difference might be enough to get someone below the poverty level threshold and qualify for premium assistance.

[MichaelB]

Quote:

Originally Posted by Mulligan Ohio, who was one of the original dozen or so states speculated to be facing "rate shock". Well it appears the original speculation may be true. Of course it all depends upon subsidies, etc. They are estimating an 88% increase based on rates submitted. They are currently under review by the state. The press release below explains it more. Ohio Department of Insurance

Thanks for the link. They are projecting an average premium of $420, which appears higher than the cost in California. They don't say why, and the price range among policies looks to be in the same ballpark.

Quote:

Estimates from a Society of Actuaries study released in 2013 showed Ohio’s current average cost to cover medical expenses for an individual health insurance plan is $223. Based on the proposals submitted to the Department, the average to cover those costs in 2014 is $420 representing an increase of 88 percent when compared to the Society of Actuaries study. The proposed rates are not effective and are currently undergoing the Department’s review process. During this process, rates may change before becoming effective.

[rbmrtn]

Quote:

Originally Posted by MichaelB The point may be that if the mortgage is paid less income is needed to support oneself, and that difference might be enough to get someone below the poverty level threshold and qualify for premium assistance.

I think that would be it. No income required to support a mortgage lowers your MAGI.

[Mulligan]

Quote:

Originally Posted by MichaelB Thanks for the link. They are projecting an average premium of $420, which appears higher than the cost in California. They don't say why, and the price range among policies looks to be in the same ballpark.

Michael, thanks for lifting the summary. My iPad, is very sporadic on what it will copy and paste. I did some reading through some of the links, that led me to the link, I posted. A few reasons they speculated were: 1) California being a "blue state" already had mass populace buy in already for purchasing insurance already, and they can count on the "healthy people" buying insurance 2) California already had "unisex" policies in place, so men were already used to paying more. 3) The California policies already had compressed "age bands" closer to the Obama 3-1 ratio, while many the states without unisex policies are closer to a 6-1 ratio.

I didn't link the original source as it brought in more opinion, which really wasn't my intent. But to sanitize it, when it gets down to it, the "rate shock " is really going to be in states that have rigorous underwriting and sex based policies. I did laugh as it they called Obamacare as the "War on the Bros". Unfortunately I am one of the Bros. If you are male, great health, and middle age or younger, you are the one getting the shock. I wouldn't be surprised that for certain populations even in Ohio outside "The Bros" the rates will not be viewed as a "shock". Because as you said earlier Michael, with heavy paraphrasing, the cost is just shifting around, the financial side of health reform is still what needs addressed.

[rodi]

Having lived in several states (WA, PA, GA, and CA) I've found CA to be cheaper for health insurance. At least southern CA. Kaiser Permanente is the biggest insurer in CA (something like 48% of the insured population. They charge almost double in Northern CA than in Southern CA according the COBRA rates of my employer. (We have facilities in both parts of the state.)

CA also has medical malpractice tort reform - and has for decades... That might be another reason why it's cheaper here. Just hope they amputate the correct limb - since your damages are limited to $250k - the same amount they were limited to in 1975 when the law passed.
Medical Injury Compensation Reform Act - Wikipedia, the free encyclopedia

[cute fuzzy bunny]

Quote:

Originally Posted by pb4uski What does paying off the mortgage have to do with health care costs? O-MAGI is before any deductions as I recall, so unless you are drawing your mortgage payments from tax-deferred funds it shouldn't matter.

It comes from looking at your finances as a whole, rather than in little boxes where you can arrive at the decision you really want more easily.

By paying off my loans, my withdrawal rate is quite low, since all I have to pay are my monthly bills, food and entertainment. As a result, my 1040 income is so low I pay little to no taxes. Its also low enough to qualify for subsidized health care rather than paying the full bill.

[pb4uski]

I think I see what your were suggesting now in that if I paid off my mortgage from my taxable investments, my taxable investments would be lower and my mortgage would be nil, so the taxable income from my taxable investments would be lower and my mortgage interest deduction would be nil.

[FinanceDude]

Quote:

Originally Posted by cute fuzzy bunny Hmm, typed in a long post and e-r.org fell off the internet for a minute! Weird. Short version: Since I got divorced, I need my own h/c. Got declined from my current provider (kaiser) because a few years ago I was prediabetic and prehypertensive. As any kaiser patient knows, they love giving you lots and lots of pills and you may never get well from any condition. I checked with some other providers, and they doubled their teaser rates on me, and when they pull the full medical history from kaiser they'll probably retroactively decline me as well. Stooopid since they HAVE to take me after 1/1. Considering I'm 169lbs, my bp is 120/72 and my recent a1c test was 5.5, I'm pretty amused that kaiser declined me. I'd actually been considering a slightly lower cost option, but I think I'll stick with them and stick it to them. I'd like ALL kinds of tests run... So I'll be stuck with kaiser on cobra at around 800-900 a month until 1/1, when I'll get on an individual plan with them. Since I paid off my mortgage, cars and other debt and my 1040 reported income is under the 400% limit, I'll get subsidized care at under $200 a month. So somebody has to go revise the 'should I pay off the mortgage' threads with a 5-10k reduction in health care costs...

CFB!!! Welcome back, sir!