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Old 09-17-2016, 10:45 AM   #61
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Maximum penalty is 2.5% or $695, whichever is greater. However the cap is $2085.

The percentage apparently will not change but the flat fee will be indexed for inflation.

But that cap keeps it low enough for people to forego paying premiums I guess.

So if someone is making $70k, he or she wouldn't be eligible for subsidies. They'd pay a penalty of $1750. Still may be preferable to paying $400-500 a month in premiums?

Or if the person is under 40, the premiums would be a lot less?

At $70k, that person may be able to accumulate some savings and other assets. So going without insurance, an accident or catastrophic illness could leave her with a big bill. Even one visit to an ER could be a bill over $10000.

So the "young invincibles" can roll the dice and pay the $1750 penalty but save $2-3k more in premiums and out of pocket maximums?
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Old 09-17-2016, 10:59 AM   #62
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What you can get for medical care if you are uncovered and walk into the ER is quite limited as I understand it... for example, if you're diagnosed with cancer then you are SOL and on your own.

While I don't doubt that there are some really stoopid people out there who will roll the dice because health insurance is too expensive, if you have anything to loose it would be foolish to go without health insurance... one minor illness and any savings you have would be wiped out.

If you don't have anything to lose then you won't get wiped out... but you could develop an illness that is not covered by walking into the ER and then either have to scramble around to try to get charity care or die.
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Old 09-17-2016, 11:23 AM   #63
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Presumably if you're not making enough to have savings or other assets, then you're likely eligible for subsidies.
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Old 09-17-2016, 11:34 AM   #64
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True, but for some people out there even after subsidies they view health insurance as too expensive and not worth the money.
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Old 09-17-2016, 11:51 AM   #65
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Ah, I see... they are just deciding to not offer individual health insurance. I understand what you are saying for large group and Medicare (I assume that you mean Medicare supplemental coverage) but I don't get Medicaid.... isn't Medicaid a government program? What is a private insurer's role with respect to Medicaid?
Around half the states, including Arizona, implement "Managed Care" Medicaid programs. Private insurance companies enroll the recipients and manage the care like any other insurance policy, except premiums are paid and coverage terms are dictated by the state.

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True, but for some people out there even after subsidies they view health insurance as too expensive and not worth the money.
No doubt not enough "young invincibles" is a legitimate cause, but the majority of people without health care in the US continue to be the working poor. In some cases they are not eligible. In other cases they are and it is not clear why they do not have coverage. This is an understudied demographic issue.
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Old 09-17-2016, 12:02 PM   #66
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It's kind of like 401k. A lot of workers starting out won't sign up for 401k because they don't want deductions from their paychecks, even if the employer matches.

So some studies show that with auto opt-in, they don't miss the deduction as much in their after-tax paychecks.

Maybe there's some kind of mental impediment to the notion of paying so much after-tax money for circumstances or eventualities which are notional.
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Old 09-17-2016, 12:51 PM   #67
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Never thought I would look forward to the day wife and I each turn 65. What a screwed up system we've cobbled together.


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Old 09-17-2016, 12:59 PM   #68
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Having seen enough ineptness and indifference of bureaucrats and politicians, I prefer a solution involving private enterprises, but somehow it's elusive.
+1 Very well stated!
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Old 09-17-2016, 12:59 PM   #69
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Presumably if you're not making enough to have savings or other assets, then you're likely eligible for subsidies.
An invalid assumption I'd say. The eligibility for subsidies is entirely delinked from assets. There are many people making enough money to pay for all or part of their own health care costs/health insurance costs. They prefer to spend all they make (and more) on other things. They may or may not be eligible for subsidies, but regardless they want me (and you) to pay for their health care if they need it (through higher health insurance premiums we pay and through taxes). The law as written (and interpreted) validates the fundamental wisdom of their position. So, we have the situation we have now.
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Old 09-18-2016, 09:27 AM   #70
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True, but for some people out there even after subsidies they view health insurance as too expensive and not worth the money.
That's certainly true for the staff at the small nonprofit I volunteer at - none of them want to pay for ACA insurance even with subsidies or penalties. They'd rather roll the dice and pay cash for visits and procedures, and these are 50+ year old folks.

I suspect if any of them had decent portfolio sizes they might look at it differently, but I don't think they do.
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Old 09-18-2016, 11:03 AM   #71
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Never thought I would look forward to the day wife and I each turn 65. What a screwed up system we've cobbled together.

Ditto on all that.
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Old 09-18-2016, 12:34 PM   #72
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I have an extended family member who decided to roll the dice (and pay the tax penalty) and go without insurance. He had a heart attack earlier this year. The hospital did not refuse to treat him - in fact he had two separate operations (2 different stents placed.) About $150k in bills.

He is still responsible for these bills. He didn't get "free" treatment. Fortunately he was able to negotiate the bill down to about $80k, borrow the money, and is making payments towards the debt.

Hind sight - he wishes he hadn't gone without insurance.

He also bought insurance for his follow on care.

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Old 09-18-2016, 12:38 PM   #73
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Never thought I would look forward to the day wife and I each turn 65.
DH turns 65 beginning of next year. So many benefits to this. Both financial (cadillac plan F suppliment and drug plan + part B is still cheaper than the HMO HSA qualified HDHP through the exchange) and convenience (since he has a different plan we have to forgo the premium tax credit up front in order to have 2 separate plans due to a "feature" of covered CA's software.)

But - going back to the issue of this thread.... I'm very fortunate to live in area where there are many carriers on covered CA for my county.
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Old 09-18-2016, 12:48 PM   #74
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How old was the guy who had the heart attack?

Does the hospital ask to see financial statements like bank statements or tax returns before agreeing to negotiate the bill down?

If they had reasons to believe he had assets or big income, would they have negotiated the bill?

Two operations and associated hospital stays could have been worse than $80k. Maybe even worse than $150k.
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Old 09-18-2016, 01:01 PM   #75
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Does the hospital ask to see financial statements like bank statements or tax returns before agreeing to negotiate the bill down?

If they had reasons to believe he had assets or big income, would they have negotiated the bill?
I recall an interview on NPR with the director of a hospital in Miami (Baptist, I think) and he affirmed they applied income tests before lowering rates. Need had to be proven, and the cutoff was pretty low - 2X the poverty rate or somewhere in that range.
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Old 09-18-2016, 03:00 PM   #76
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I recall an interview on NPR with the director of a hospital in Miami (Baptist, I think) and he affirmed they applied income tests before lowering rates. Need had to be proven, and the cutoff was pretty low - 2X the poverty rate or somewhere in that range.
Of course if you have no assets or at least no unprotected ones after a big medical bill there is always bankruptcy which does extinguish medical bills. That is the big club you have over the medical providers to reduce the bill, in that something is better than nothing.
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Old 09-18-2016, 03:46 PM   #77
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Yeah so for ER people, it's not just health insurance, it's savings insurance as well.
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Old 09-18-2016, 03:56 PM   #78
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Never thought I would look forward to the day wife and I each turn 65. What a screwed up system we've cobbled together.


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Yep, it's the new Holy Grail of insurance. Enjoy it while it is still available and doctors still accept it, which is becoming less and less.
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Old 09-18-2016, 06:10 PM   #79
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Yeah so for ER people, it's not just health insurance, it's savings insurance as well.
Exactly! Two main reasons to carry health insurance... 1) Prevent financial ruin in the event of a serious illness or disease and 2) Gain access to negotiated rates with medical care providers.

Ditto for health insurance on your kids... I insist they carry health insurance so I don't get put into a spot of paying a big bill to get them the care that they need... I would pay for it if I needed to... but don't tell them.
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