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Old 11-21-2015, 01:36 PM   #61
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...........I read about a month ago a thought (article or blog) that expressed, wouldn't it be nice if there was a super HSA. As things stand now, the very wealthy don't benefit from subsidies and the poorer can't afford to utilize an HSA and the eligible HSA deduction is no real benefit to them...............
I was under the impression that employer provided insurance was tax free. If you are very wealthy, that would put you in the 39% tax bracket. Wouldn't tax free health insurance be a subsidy?
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Old 11-21-2015, 01:48 PM   #62
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... people are wanting lowest possible price and maximum use of services....

My favorite example of insurance was a letter an insurance company released a few years ago from a very happy customer. She wrote the company about how pleased they were with all the coverage they provided. She said she got married and was wanting a baby so she picked their insurance because she heard good things about them. Then she said she was dropping them since they are not having any more children. But if they ever did she wanted them to know she was going to sign back up with them. You just cant make this stuff up!
We know good things about just-in-time (JIT) manufacturing. Now, we have JIT health insurance.

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...
The biggest problem with the ACA is the fact that healthcare is very expensive in the US, but this high cost is only really visible on individual ACA policies. Medicare and employer policies (and other sources) cost just as much, but those costs are not put on public display for all to see and discuss.
+1

When it is OPM, people do not care that much. Well, except that Medicare and employer-provided money are not OPM either. It all comes out of our pockets, just indirectly in the form of higher taxes or lower pays.
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Old 11-21-2015, 01:50 PM   #63
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I think a push or not depends a lot on who gets elected next year. If the side that is for the ACA is elected, that'll be at least 4 more years of the ACA as law of the land. If the side that is for repeal gets elected, then all bets are off (or the push to repeal might be a, "Oh, never mind").

I read about a month ago a thought (article or blog) that expressed, wouldn't it be nice if there was a super HSA. As things stand now, the very wealthy don't benefit from subsidies and the poorer can't afford to utilize an HSA and the eligible HSA deduction is no real benefit to them.

I didn't post a link to article/blog as that started out like "This political side thinks such and such and the other side thinks this", so I avoided the Porky. But IMO, the thought of a super HSA is intriguing.

Hey, I would party all night long if that ever came to be. But lets be honest...That would only benefit rich people or people like me...Meaning someone who can still afford it, but complains mightily about the cost. And it certainly doesn't address cost containment or help low incomers.


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Old 11-21-2015, 02:13 PM   #64
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Hey, I would party all night long if that ever came to be. But lets be honest...That would only benefit rich people or people like me...Meaning someone who can still afford it, but complains mightily about the cost. And it certainly doesn't address cost containment or help low incomers.


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The gist of that blog/article (which I can't find ) was about how to best get everyone insured and yet have a system that would work for both sides. At least according to the author.
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United Health may stop offering ACA Exchange plans
Old 11-21-2015, 02:21 PM   #65
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United Health may stop offering ACA Exchange plans

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The gist of that blog/article (which I can't find ) was about how to best get everyone insured and yet have a system that would work for both sides. At least according to the author.

Just about everyone would have an subsidy then if we could add that in with existing subsidies....Except who is going to pay for it? The middle class just above the subsidy line and dont make enough to save for the deduction?


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Old 11-22-2015, 01:54 AM   #66
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If ACA is repealed or implodes, and the US health insurance market and/or cost of healthcare becomes hard to afford or obtain, is anyone else thinking of retiring to another country for better, more affordable healthcare? If yes, what countries are worth looking at? I am not waiting until age 65 to retire just so I can have some crappy health insurance policy that doesn't pay anything through my employer.

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Old 11-22-2015, 07:51 AM   #67
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If ACA is repealed or implodes, and the US health insurance market and/or cost of healthcare becomes hard to afford or obtain, is anyone else thinking of retiring to another country for better, more affordable healthcare? If yes, what countries are worth looking at? ..........
Yea, I can pretty easily see 300 million Americans moving to say, Canada or Thailand. This might be a real estate opportunity.
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Old 11-22-2015, 08:18 AM   #68
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Yea, I can pretty easily see 300 million Americans moving to say, Canada or Thailand. This might be a real estate opportunity.

Yes there are easier options that many people already utilize. 1) Just not buy it 2) Stiff the company when billed 3) Tell them you cant pay, and negotiate $20 a month for years on end 4) Sign up during the ACA window, utilize the heck out of it for first couple months for all your needs, then drop it till next year.


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Old 11-22-2015, 08:50 AM   #69
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I think any new program has startup problems. Studying the history of Medicare confirms this. Give ACA a few years.
Thing is, even on this forum of above average intelligent, savvy people there remains a ton of confusion. I've been following it for over a year now and still don't have my arms completely around how this is supposed to work.

This isn't startup problems. I spent my whole career in "new product rollouts".
This is a program that wasn't fully thought out, poorly executed and even more poorly explained. I've yet to meet an average Joe who has any clue on how this works.

It's as if everybody said: "Ok, we got it into law" and then just walked away as if the passing was the goal and not the starting point.

The bad news is the next time someone want to pass some good sweeping legislation, the implementation of this mess will be pointed to as a reason not to.
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Old 11-22-2015, 08:53 AM   #70
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It's as if everybody said: "Ok, we got it into law" and then just walked away as if the passing was the goal and not the starting point.
Normally the sane, reasonable thing to do (IMO) is to look at what is working, what is not working, and legislate to build on the successes while addressing the actual or potential failures. Unfortunately that mindset seems to be in *very* short supply at the Capitol these days, with one group wanting to blow up the law almost entirely, and the other spending all their time preventing such a thing (and thus defending the status quo).
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Old 11-22-2015, 08:57 AM   #71
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.......It's as if everybody said: "Ok, we got it into law" and then just walked away as if the passing was the goal and not the starting point..............
Revolution is always much easier than governing. It will work out in the end - we're still quarreling over exactly what the Constitution means.
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Old 11-22-2015, 09:58 AM   #72
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Normally the sane, reasonable thing to do (IMO) is to look at what is working, what is not working, and legislate to build on the successes while addressing the actual or potential failures. Unfortunately that mindset seems to be in *very* short supply at the Capitol these days, with one group wanting to blow up the law almost entirely, and the other spending all their time preventing such a thing (and thus defending the status quo).

I read an article on this issue concerning United and its exchange problems today. One "expert" thinks the marketplace will evolve in a different manner. First he blamed United for its own problem as they offered broad networks for their plans thus not controlling costs. He said this market will undergo a "massive shift away from traditional insurers toward managed care providers that specialize in Medicaid and other government programs. He also said, "In short order, Obamacare is evolving into a Medicare marketplace, not only in terms of design and quality of the narrow network plans being offered, but in the actual carriers that sell those policies".


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Old 11-22-2015, 10:17 AM   #73
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If they can't make their margin, they will drop that part of the business.
I would certainly hope so!

Our gov't set up ACA with rules they thought would allow insurers to operate and make a profit. Insurers analyzed the numbers and some made the decision to participate (with the objective of making a profit from their participation). Now that some time has passed, some insurers are either changing their offerings or dropping out altogether. That's how our economy works.

The fact that UHC feels that the effort and investment in ACA participation would be better spent someplace else is fine. The least efficient (in this particular business niche) has dropped out. Hooray! The system kinda works!

I expected change in who is participating and what the offerings are from the get-go. I'm also expecting more change in the future.
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Old 11-22-2015, 10:32 AM   #74
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If the post that showed that insurance companies are only making a 2% profit on the ACA business then I would have to ask how long they will stay in the program? Publicly held companies are expected to return a better ROE to their shareholders than 2%, and an insurance company would be likely to drop out of this line of business before their bottom line suffers too much. There will need to be more subsidy of losses by the taxpayers to keep the companies in the marketplace.

One of the problems facing the companies that got into writing insurance for the marketplace is that they had no way to know what their results would be when they started taking new customers that had pre-existing conditions and medical needs that are greater than the premiums they pay going in. The previously uninsured and uninsurable are now being charged the same premiums as the healthy people and no one knew going in what the costs would have to be to cover the group and still make a profit. Their past history of underwriting risk goes out the window when they had to take all comers without being able to price them according to the exposure they present.
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Old 11-22-2015, 12:22 PM   #75
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If the post that showed that insurance companies are only making a 2% profit on the ACA business then I would have to ask how long they will stay in the program? Publicly held companies are expected to return a better ROE to their shareholders than 2%, and an insurance company would be likely to drop out of this line of business before their bottom line suffers too much.
Can you clarify which post were you referencing? I thought that health insurers are generally in the 2% range when profit is measured as a function of revenue as opposed equity.
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Old 11-22-2015, 02:02 PM   #76
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This link contains a chart showing the projected profit of 2% for plans on the exchanges. It shows a 2,7% profit for plans off the exchanges. Not good, but a tad better. If profits are that thin it takes a tremendous amount of business to make the cash flow large enough to invest to generate a better return. That may explain the recent mergers.
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Old 11-22-2015, 02:49 PM   #77
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This article surveys the political implications of the ACA overall and whether UH's announcement is signs of more trouble to come.

One thing it notes is that more people have been willing to pay the penalty rather than enrolling:

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So far, at least, Obamacare’s mix of carrots and sticks isn’t working terribly well. The reason insurers are having such a hard time is that the people who are buying insurance on the Obamacare exchanges are in much poorer health than insurers had anticipated, partly because healthier people are shying away from buying policies they consider much too expensive.
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This is not to say that healthy people won’t eventually be corralled into buying insurance on the Obamacare exchanges. The individual mandate penalty is set to increase dramatically over the next two years, which might persuade some stragglers to buy insurance policies they don’t find particularly attractive. It’s just not clear that a “buy this insurance policy—or else” message will sell politically.
UnitedHealth Group sustaining heavy losses: Is Obamacare doomed?

Here are the details on the increase in the penalty for not enrolling:

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The fee for not hav*ing health in*sur*ance next year won’t be felt un*til Amer*ic*ans file their fed*er*al taxes due April 2017. But it’s much more than in the past: $695 per adult and $347.50 per child, or 2.5 per*cent of a house*hold’s in*come—whichever is high*er. When tax*pay*ers file their 2015 taxes (due this April), the fee for for*go*ing in*sur*ance will be $325 per adult and $162.50 per child, or 2 per*cent of house*hold in*come if the lat*ter fig*ure is high*er.
NationalJournal

Now is that 2.5% of AGI or MAGI or gross when they say "household income?" Median household income is around $50k so would that mean $1250 penalty?

Last year, 7.5 million Americans paid the fee:

Quote:
About 7.5 mil*lion tax*pay*ers paid a total of $1.5 bil*lion for not hav*ing health cov*er*age. This was high*er than the Treas*ury De*part*ment es*tim*ate that 3 to 6 mil*lion tax*pay*ers would pay the fee. (12 mil*lion Amer*ic*ans without in*sur*ance were ex*emp*ted due to cer*tain hard*ships, fin*an*cial status, and life events).
Where do the collected fees go to?
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Old 11-22-2015, 03:23 PM   #78
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Yea, I can pretty easily see 300 million Americans moving to say, Canada or Thailand. This might be a real estate opportunity.
Most Americans are not early retirees who have the ability to move elsewhere if health insurance/healthcare costs in the US become unaffordable or unattainable. I have health insurance through my employer right now, but even that policy is very expensive and does not cover anything until I spend a ton of money. Spending half of my income on health care and health insurance in retirement is crazy. If ACA is repealed, I might not even be able to get health insurance because the high risk state insurance pools no longer exist.

Anyway, I am just trying to identify contingency plans if ACA does not survive for one reason or another.
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Old 11-22-2015, 03:28 PM   #79
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Most Americans are not early retirees who have the ability to move elsewhere if health insurance/healthcare costs in the US become unaffordable or unattainable. I have health insurance through my employer right now, but even that policy is very expensive and does not cover anything until I spend a ton of money. Spending half of my income on health care and health insurance in retirement is crazy. If ACA is repealed, I might not even be able to get health insurance because the high risk state insurance pools no longer exist.

Anyway, I am just trying to identify contingency plans if ACA does not survive for one reason or another.
I understand. Hopefully our government will be functional enough to find solutions that don't require us to emigrate just to have health care.
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Old 11-22-2015, 03:29 PM   #80
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This article surveys the political implications of the ACA overall and whether UH's announcement is signs of more trouble to come.



One thing it notes is that more people have been willing to pay the penalty rather than enrolling:











UnitedHealth Group sustaining heavy losses: Is Obamacare doomed?



Here are the details on the increase in the penalty for not enrolling:







NationalJournal



Now is that 2.5% of AGI or MAGI or gross when they say "household income?" Median household income is around $50k so would that mean $1250 penalty?



Last year, 7.5 million Americans paid the fee:







Where do the collected fees go to?

I guarantee you the people who paid the penalty have no clue about the exemptions. Just not pay your water bill a month and get it shut off and you have enough reason to not pay penalty. Heck I am single with 80k income and there are a few ways I could avoid paying the penalty myself.
http://www.forbes.com/sites/mikepatt...oid-a-penalty/




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