Patient Protection and Affordable Care Act

[marko]

I have to say that they did a lousy job at selling/marketing this!

A lot of resistance/pain could've been avoided if everyone had got a flier/notification of a website with just 10 points on: 1) why this is good for you, 2) how this is different from what you have, 3) what it will cost you.

Not 3000 pages...just 10 bullet points.

For instance, I was against this act until YESTERDAY when I realized (through this forum) that it has the potential to drop my HC premium from $15K to $5K!

I doubt most self insuring Americans realize that they can get a $izable subsidy.

We had to pass this law in order to find out what's in it??!!

Just poor marketing.

 

[samclem]

I have to say that they did a lousy job at selling/marketing this!

A lot of resistance/pain could've been avoided if everyone had got a flier/notification of a website with just 10 points on: 1) why this is good for you, 2) how this is different from what you have, 3) what it will cost you.

Not 3000 pages...just 10 bullet points.

I'm surprised anyone could be on this site for more than a few weeks and not get exposed to the info needed. Anyone who can't use Google to do a search is unlikely to be saved by a leaflet. This info has been well packaged and presented on many sites. No issue has been more thoroughly discussed and debated, with plenty of information from all "combatants"--often in the all-too-simplistic sound-byte style you are yearning for. No short leaflet can adequately cover the ramifications of the passage of this law. Anyone looking strictly at the promised subsidy and planning to apply that money to their present insurance rate is definitely not getting the whole picture. Rates are going to change, availability of care is going to change, and delivery mechanisms are going to change. Hang on.

 

[Purron]

I read an opinion piece this morning which I don't want to link to since it's very political. One thing that interested in me in the article was a statement regarding the lack of penalties on individuals. I confirmed this by going directly to the bill which I read here on the Government Printing Office (GPO) website:

http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf

From the bill:


‘‘(2) SPECIAL RULES.—Notwithstanding any other provision of law—
‘‘(A) WAIVER OF CRIMINAL PENALTIES.—In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
‘‘(B) LIMITATIONS ON LIENS AND LEVIES.—The Secretary shall not—
‘‘(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or‘‘(ii) levy on any such property with respect to such failure.’’.

Since non-payment of the penalty will not result in criminal charges, liens, levies, or additional penalties, it appears a taxpayer could avoid payment simply by making sure they are not due a refund. If any taxes due are paid, other than the penalty payment under the PPACA, it looks as though no collection actions would be taken or additional penalties placed.

I thought this might be of interest, particularly to those people who choose to self insure for health care by earmarking sufficient savings to cover anticipated medical costs.

 

[Mulligan]

I have to say that they did a lousy job at selling/marketing this!

A lot of resistance/pain could've been avoided if everyone had got a flier/notification of a website with just 10 points on: 1) why this is good for you, 2) how this is different from what you have, 3) what it will cost you.

Not 3000 pages...just 10 bullet points.

For instance, I was against this act until YESTERDAY when I realized (through this forum) that it has the potential to drop my HC premium from $15K to $5K!

I doubt most self insuring Americans realize that they can get a $izable subsidy.

We had to pass this law in order to find out what's in it??!!

Just poor marketing.

Personally, I think who may be in favor or against it, probably depends on which side of the "$izable subsidy" fence you sit on. Being a person with currently cheap individual insurance and guaranteed monthly income above the subsidy line this may put someone like me behind the 8 ball, if subsidized costs spiral out of control. I am withholding judgement for a while and will let things play out. I don't mind paying a little more for the greater good, but I worry people with decent fixed monthly incomes but modest assets, could be possibly be exposed way more than people who can adjust yearly income, but have sizable assets if premium costs become unruly. I hope the HSA and its contribution amounts are allowed to stay intact as presently it appears. That is the only meaningful deduction I have left.

 

[explanade]

Since non-payment of the penalty will not result in criminal charges, liens, levies, or additional penalties, it appears a taxpayer could avoid payment simply by making sure they are not due a refund. If any taxes due are paid, other than the penalty payment under the PPACA, it looks as though no collection actions would be taken or additional penalties placed.

I thought this might be of interest, particularly to those people who choose to self insure for health care by earmarking sufficient savings to cover anticipated medical costs.

It also seems like the penalties will be far lower than most premiums. If that is the case what's to prevent somebody from paying the penalties and only buying insurance when they need it?

 

[Purron]

It also seems like the penalties will be far lower than most premiums. If that is the case what's to prevent somebody from paying the penalties and only buying insurance when they need it?

Nothing I can see, but what would happen if they had an accident, heart attack, or some other medical condition requiring immediate treatment?

 

[donheff]

Nothing I can see, but what would happen if they had an accident, heart attack, or some other medical condition requiring immediate treatment?

MA allegedly has 98% insured with a similar system with weak penalties. Most people who can afford HI want it because an accident, cancer or whatever can cost them a bundle before they will be able to get a policy. Very poor people will get Medicaid and borderline (e.g. some of this board's ERers) will get enough help to make the proposition attractive. Only a relatively small number of outliers will blow it off - many probably because they are so out of touch the won't even realize they are eligible for subsidies.

 

[MichaelB]

Even if they lack the votes to repeal some states are saying they won't implement.

And you could have an administration hostile to the law put in charge of implementing it.

State health exchanges will be implemented regardless because a federal offering will be made if the state chooses not to. Expansion of Medicaid is optional, by state.

A few members are trying to figure out what could stop this, but most are looking at how it affects them and how they should take advantage of it. I think the rest of the country, people, businesses and institutions, are doing the same thing. As the implementation momentum builds it will be more likely to continue.

Upcoming elections can change that and many other things as well. This is something always present that we can acknowledge and consider in our plans.

It also seems like the penalties will be far lower than most premiums. If that is the case what's to prevent somebody from paying the penalties and only buying insurance when they need it?

It appears individuals today are choosing to have insurance rather than not have it. Some people may game the system but most appear to want coverage.

 

[Brat]

One way to prevent 'just in the nick of time' behavior is to limit coverage opportunities to once or twice a year and upon specific events (marriage, birth of a child, loss of a job) as employers do today.

 

[Mulligan]

One way to prevent 'just in the nick of time' behavior is to limit coverage opportunities to once or twice a year and upon specific events (marriage, birth of a child, loss of a job) as employers do today.

Your comment reminded me of a poster a few days back wrote the state of Washington tried guaranteed coverage. He commented a lady wrote to the insurance company thanking them for paying all the bills on her pregnancy. She wrote that if she ever needed health insurance again, she promised to use them. That still cracks me up. I haven't decided yet if she is one of the dumbest people I have heard about, or the smartest.

 

[MichaelB]

One way to prevent 'just in the nick of time' behavior is to limit coverage opportunities to once or twice a year and upon specific events (marriage, birth of a child, loss of a job) as employers do today.

That's what insurance companies do now in Florida for small business policies of 1. Enrollment is October 1 and the window is 8/1 thru 8/31.

 

[tapper]

This from the Kaiser Family Foundation summary. Nowhere near 60. More like 6, if you count new taxes and changes in tax rates.

• Increase the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income for regular tax purposes; waive the increase for individuals age 65 and older for tax years 2013 through 2016. (Effective January 1, 2013)

Is there anything in the law to allow for a deduction for health insurance? It doesn't seem very fair that group policy holders get an implicit deduction while individual policy holders don't. The upward adjustment to unreimbursed medical expenses seems to be applying some salt to the wound.

 

[scrabbler1]

Is there anything in the law to allow for a deduction for health insurance? It doesn't seem very fair that group policy holders get an implicit deduction while individual policy holders don't. The upward adjustment to unreimbursed medical expenses seems to be applying some salt to the wound.

This unequal tax treatment bugs me, too. Those in group policies through their employer pay no tax on the employer-paid portion, then can use pretax dollars on their share even if they do not itemize deductions on their income tax retrns. But those of us with individual policies can at best deduct part of our premiums (and soon a lesser part of those premiums) but cannot deduct the rest of the premiums. And if we don't itemize, we can't deduct any of it.

Having just switched from a group policy to an individual one in 2009, I have seen this change first hand. And now that I won't be itemizing every year, it only gets worse for those of us FIREd.

 

[easysurfer]

Okay, so I go to a website (not going to give the link here as some consider it too political) that asks to enter a few info (age, state of residence, annual income, do you have current insurance or denied in the past, etc.). I put in some numbers that a person in ER might have. Then out comes a recommended report.

One of the results, might want to consider medicaid. Is that a glitch in the ACA? For example, if one if financially independent enough to FIRE, but doesn't have wage income anymore, would medicaid really be the appropriate option to look into?

I remember, when I FIRE'd and told my boss, during my exit interview, he asked me "So, do you need to file for unemployment now?" I said, "Nope, I called it a career."

 

[ziggy29]

One of the results, might want to consider medicaid. Is that a glitch in the ACA? For example, if one if financially independent enough to FIRE, but doesn't have wage income anymore, would medicaid really be the appropriate option to look into? "

As I recalled, ACA expanded Medicaid eligibility up to incomes of 138% of the federal poverty line. So if someone can live an acceptable (to them) lifestyle on that income level or less...

Who Benefits from the ACA Medicaid Expansion? - Kaiser Family Foundation

One thing that historically could vary from state to state is asset limits on top of income limits.

 

[easysurfer]

As I recalled, ACA expanded Medicaid eligibility up to incomes of 138% of the federal poverty line. So if someone can live an acceptable (to them) lifestyle on that income level or less...

Who Benefits from the ACA Medicaid Expansion? - Kaiser Family Foundation

One thing that historically could vary from state to state is asset limits on top of income limits.

Thanks for the link.

That's very interesting. I see the rationale about both asset limits on top of income limits.

As an extreme example, lets say Mr. Chicken only invests in Money Market Funds. He carrys his entire life savings in a MMF that, at the paltry interest rates, earns him $15K in dividends a year. No other income. To earn $15K in dividends alone in a MMF still requires a pretty large amount. Yet, he'd still qualify for medicaid if there is no asset limit...

Interesting..

 

[donheff]

Thanks for the link.

That's very interesting. I see the rationale about both asset limits on top of income limits.

As an extreme example, lets say Mr. Chicken only invests in Money Market Funds. He carrys his entire life savings in a MMF that, at the paltry interest rates, earns him $15K in dividends a year. No other income. To earn $15K in dividends alone in a MMF still requires a pretty large amount. Yet, he'd still qualify for medicaid if there is no asset limit...

Interesting..

Yeah, we can parse things a million ways but how many of marginal income FIRE folks are out there to worry about. Most people in the situation you mention will be over 65 and on Medicare. Most of the rest will be temporarily unemployed and looking for work (a good example of people who could use a subsidy). The few young intentional ERers that sneak thru are winners on the ACA sweepstakes.

 

[Mulligan]

This unequal tax treatment bugs me, too. Those in group policies through their employer pay no tax on the employer-paid portion, then can use pretax dollars on their share even if they do not itemize deductions on their income tax retrns. But those of us with individual policies can at best deduct part of our premiums (and soon a lesser part of those premiums) but cannot deduct the rest of the premiums. And if we don't itemize, we can't deduct any of it.

Having just switched from a group policy to an individual one in 2009, I have seen this change first hand. And now that I won't be itemizing every year, it only gets worse for those of us FIREd.

I agree, also with you. I would have loved an increased HSA contribution limit too!

 

[clifp]

This from the Kaiser Family Foundation summary. Nowhere near 60. More like 6, if you count new taxes and changes in tax rates.

Well the tanning bed tax makes it 7 taxes.

 

[Mulligan]

Well the tanning bed tax makes it 7 taxes.

This article says 21 taxes.

The high court’s ruling leaves in place 21 tax increases in the health care law costing more than $675 billion over the next 10 years, according to the House Ways and Means Committee. Of those, 12 tax hikes would affect families earning less than $250,000 per year, the panel said, including a “Cadillac tax” on high-cost insurance plans, a tax on insurance providers and an excise tax on medical-device manufacturers.

http://p.washingtontimes.com/news/2012/jun/28/republicans-ruling-focuses-election-obamas-health-/

 

[Nords]

... when do we see a thread on 'controlling your taxable income' pop up?
Many of us seem to be just above the thresholds...a little creativeness would drop us below.

Getting back to this question, I think that's a perpetual thread not necessarily related to healthcare.

Most ERs spend considerable effort controlling their taxable income after they ER so that they can do Roth IRA conversions, enjoy long-term unrealized cap gains, and minimize their SWRs.

 

[Purron]

Getting back to this question, I think that's a perpetual thread not necessarily related to healthcare.

Most ERs spend considerable effort controlling their taxable income after they ER so that they can do Roth IRA conversions, enjoy long-term unrealized cap gains, and minimize their SWRs.

True Nords, but doesn't the PPACA add another dimension to controlling taxable income? Does for DH and I since we haven't or plan to do roth conversions plus have miminal capital gains. Don't think we're the only ones...

 

[Nords]

True Nords, but doesn't the PPACA add another dimension to controlling taxable income? Does for DH and I since we haven't or plan to do roth conversions plus have miminal capital gains. Don't think we're the only ones...

Don't know, and it's probably too early to speculate until the IRS starts coughing out new pubs & forms...

 

[Purron]

Don't know, and it's probably too early to speculate until the IRS starts coughing out new pubs & forms...

Now that will be an occasion worthy of a new thread

 

[devans0]

Fine print or the market can change plans but the guaranteed coverage part of PPACA means I have just joined the January class of 2014. Roth/IRA taxes adds another wrinkle to keep life interesting.