Patient Protection and Affordable Care Act

[shotgunner]

There is still a lot of the law that needs to be "fleshed out". The final format and rules and such will not be completed for a couple years or so. The 2700 pages was merely a basic infrastructure...........

I agree but they have got roughly 14.5 months to get it fleshed out. Open season for purchase of HI through exchanges starts on 10/1/13. Penalty for not having qualified HI plan in place starts 1/1/14.

 

[hguyw]

I'm been following the thread closely and visited most of the links provided - I know a lot more now than I did. Many thanks to those who have worked to keep it from derailing!

I do have a question about my situation, however. I'm ER'd and on my former employer's health insurance, for which I now pay $341/month which equals half the monthly premium. As HI goes these days, that's not bad, but it's more than 9.5% of my AGI. With what we currently know, would I be eligible for a subsidy while keeping this insurance - or would I have to give it up and buy through the exchange in order to get a better price/subsidy?

I haven't been able to find anything on this; hoping some folks on here are/will be in a similar situation and have run across the answer.

 

[MichaelB]

I'm been following the thread closely and visited most of the links provided - I know a lot more now than I did. Many thanks to those who have worked to keep it from derailing!

I do have a question about my situation, however. I'm ER'd and on my former employer's health insurance, for which I now pay $341/month which equals half the monthly premium. As HI goes these days, that's not bad, but it's more than 9.5% of my AGI. With what we currently know, would I be eligible for a subsidy while keeping this insurance - or would I have to give it up and buy through the exchange in order to get a better price/subsidy?

I haven't been able to find anything on this; hoping some folks on here are/will be in a similar situation and have run across the answer.

From this KFF brief on the subsidy if your employers plan does not meet certain levels of coverage or it is unaffordable you would need to get a policy from the exchange, but your would be eligible for subsidies.

http://www.kff.org/healthreform/upload/7962-02.pdf

Who is eligible for premium tax credits?

Citizens and legal residents in families with incomes between 100% and 400% of poverty who purchase coverage through a health insurance exchange1 are eligible for a tax credit to reduce the cost of coverage. People eligible for public coverage and people offered coverage through an employer are not eligible for premium tax credits unless the employer plan does not have an actuarial value of at least 60%2 or unless the person’s share of the premium for employer-sponsored insurance exceeds 9.5% of income. People who meet these thresholds for unaffordable employer-sponsored insurance are eligible to enroll in a health insurance exchange and may receive tax credits to reduce the cost of coverage purchased through the exchange.

 

[ziggy29]

People who meet these thresholds for unaffordable employer-sponsored insurance are eligible to enroll in a health insurance exchange and may receive tax credits to reduce the cost of coverage purchased through the exchange.

One thing I heard is that it *might* be possible that if states choose not to set up exchanges, the people in those states may not be eligible for subsidies (that is, the federal fallback exchange couldn't give the credits, only the state exchanges could). Now this can get political and I'm not looking to go there, but has anyone seen anything *concrete* on whether or not this is the case? If it is true, it seems like the states who are refusing to implement exchanges are giving the middle finger to their own residents.

 

[fisherman]

There is still a lot of the law that needs to be "fleshed out". The final format and rules and such will not be completed for a couple years or so. The 2700 pages was merely a basic infrastructure...........

Actually that is not correct although it has been repeated a lot on certain news channels. The actual page count is 906 and that includes the reprint of many existing laws that are used in it. Here is a link to this info: Patient Protection and Affordable Care Act - Wikipedia, the free encyclopedia

 

[M Paquette]

One thing I heard is that it *might* be possible that if states choose not to set up exchanges, the people in those states may not be eligible for subsidies (that is, the federal fallback exchange couldn't give the credits, only the state exchanges could). Now this can get political and I'm not looking to go there, but has anyone seen anything *concrete* on whether or not this is the case? If it is true, it seems like the states who are refusing to implement exchanges are giving the middle finger to their own residents.

There was a paper published hypothecating that the way one section of the PPACA was written that there could be no subsidy for the exchanges established for each state by a federal program. The paper appears to be constructed for a particular viewpoint, judging by the somewhat unusual semantic weighting for an academic publication (I'm trying to be polite here...):

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2106789

The paper focuses on Section 1321 of the PPACA, to construct the argument. It ignores Section 1311 which is pretty explicit but inconvenient to their argument. It is very likely that in the inevitable court challenge that the construction of Section 1321 will be declared to be a scriveners error, and the intent presented elsewhere in the law and in supporting arguments as to the intent of the law from Congressional testimony will be upheld.

If a state refuses or otherwise fails to set up an exchange, the federal program will construct an exchange for that state. It'll still be a state exchange, offering qualified policies for that states residences, and the credits will very likely be there.

 

[ziggy29]

If a state refuses or otherwise fails to set up an exchange, the federal program will construct an exchange for that state. It'll still be a state exchange, offering qualified policies for that states residences, and the credits will very likely be there.

Hope you're right and this is just "full of sound and fury, signifying nothing" (to channel Shakespeare).