Nice summary from Ways and Means on proposed changes to ACA released today...

[HFWR]

After reading this thread, I am more grateful than ever for having heavily-subsidized retiree HI through a former employer...

 

[bamsphd]

After reading this thread, I am more grateful than ever for having heavily-subsidized retiree HI through a former employer...

Hope you keep it. My dad's former employer basically went to a fixed medical compensation system effective 1/1/2017. So now he gets some money to buy coverage, but it won't be increasing as costs/inflation increase, and I don't think it was enough to even fully cover this year's coverage.

 

[HFWR]

Hope you keep it. My dad's former employer basically went to a fixed medical compensation system effective 1/1/2017. So now he gets some money to buy coverage, but it won't be increasing as costs/inflation increase, and I don't think it was enough to even fully cover this year's coverage.

With 2.5 years until Medicare, I'm reasonably confident that no dramatic changes are in store. It's changes to Medicare that concern me more.

 

[audreyh1]

From what I've read, the high risk pools would be for those who cannot afford the premiums in the individual market place. So to we will all have "access" to health insurance, though it might just cost a zillion dollars a year for premiums.

In California, pre-ACA, the high risk pool qualifications were that health care customers had to be without insurance for 6 months to qualify and then there was a long waiting list to get in and limited coverage. So they weren't really a viable option for anyone who had other choices or assets to protect.

This doesn't make sense to me. Historically, a high risk pool was for folks who were denied insurance because they had a pre-existing condition.

So the idea of high risk pools to me means bringing back medical underwriting.

If it's for folks who simply couldn't afford insurance, they wouldn't be using the term "high risk".

If it's because their premiums are way higher because "they are expensive to treat" then it means medical underwriting has returned in some form.

 

[daylatedollarshort]

This doesn't make sense to me. Historically, a high risk pool was for folks who were denied insurance because they had a pre-existing condition.

So the idea of high risk pools to me means bringing back medical underwriting.

If it's for folks who simply couldn't afford insurance, they wouldn't be using the term "high risk".

If it's because their premiums are way higher because "they are expensive to treat" then it means medical underwriting has returned in some form.

This is one of the articles I read:

"The Republican bill would also resurrect high-risk pools to provide coverage for hard-to-ensure plan members. The GOP proposal would provide $100 billion for the risk pools over 10 years and allow states to use them to provide financial support for low-income enrollees who might not be able to afford coverage with the flat tax credit.

In California, high-risk pools were previously tried without success, according to Pan, with long waiting lists of those with chronic conditions trying to obtain coverage from an underfunded program."

Republican plan to repeal Obamacare alarms California Democrats | The Sacramento Bee

 

[MichaelB]

Section 132 of the Energy and Commerce Bill allocates funds to the states to cover high risk individuals.

This section establishes the Patient and State Stability Fund, which is designed to lower patient costs and stabilize State markets

The language in the summary does not use the term "high risk pool" but the description clearly has that in mind.

Helping, through the provision of financial assistance, high-risk individuals who do not have access to health insurance coverage offered through an employer enroll in health insurance coverage in the individual market in the State, as such market is defined by the State (whether through the establishment of a new mechanism or maintenance of an existing mechanism for such purpose).

• Providing incentives to appropriate entities to enter into arrangements with the State to help stabilize premiums for health insurance coverage in the individual, as such markets are defined by the State.

• Reducing the cost of providing health insurance coverage in the individual market and small group market, as such markets are defined by the State, to individuals who have, or are projected to have, a high rate of utilization of health services (as measured by cost).

• Promoting participation in the individual market and small group market in the State and increasing health insurance options available through such market.

• Promoting access to preventive services, dental care services (whether preventive or medically necessary), vision care services (whether preventive or medically Section-by-Section – Page 7 necessary), or any combination of such services, as well as mental health and substance use disorders.

• Providing payments, directly or indirectly, to health care providers for the provision of such health care services as are specified by the Administrator.

• Providing assistance to reduce out-of-pocket costs, such as copayments, coinsurance, premiums, and deductibles, of individuals enrolled in health insurance coverage in the State.

 

[simple girl]

From what I've read, the high risk pools would be for those who cannot afford the premiums in the individual market place. So to we will all have "access" to health insurance, though it might just cost a zillion dollars a year for premiums.

In California, pre-ACA, the high risk pool qualifications were that health care customers had to be without insurance for 6 months to qualify and then there was a long waiting list to get in and limited coverage. So they weren't really a viable option for anyone who had other choices or assets to protect.

Yep. Here is a great educational article on high-risk pools, for anyone who is interested.

High-Risk Pools For Uninsurable Individuals | The Henry J. Kaiser Family Foundation

 

[kcowan]

People buy travel insurance. Unless they are absolutely crazy. If they have a significant health problem, they try to get back to Canada asap. Pre-existing health problems are often the end to the snowbird lifestyle (to the US at least) as insurance becomes unaffordable for most.

In Mexico, more Americans return home for their Medicare coverage than Canadians. Of course this might be changing! Travel insurance for Canadian covers both US and elsewhere.

The best price/performing wines are from Argentina these days. Costco sell a very good Finca Malbec for 470 pesos/case of 6. Of course they also have cheaper wines. And much more expensive ones.

Canada has some warm areas that grow fine wines. But their prices and volume prevent them from being exported. Friends own a 184 acre estate winery in the south Okanagan but sell most of their products to local BC restaurants (Burrowing Owl). I think the Columbia Valley in Washington has the same problem (little need to export their fine products).

 

[Meadbh]

The best price/performing wines are from Argentina these days. Costco sell a very good Finca Malbec for 470 pesos/case of 6. Of course they also have cheaper wines. And much more expensive ones.

Do you mean this one? I really like it. $12.99 at BC Liquor stores.

MALBEC - FINCA LOS PRIMOS | BC Liquor Stores

 

[rodi]

In general, large employer group plans are "must insure", which means all employees must be covered, and charge one premium to all participants, without distinction to age or gender. There are many cases of married couples, working for different employers, both employers paying for family coverage.

My experience with a large employer was there was no age component in pricing - as a middle aged (older) employee with an even older husband, plus two kids - I paid the same as an employee 20 years younger than me - and his wife and 2 kids.

Smaller employers are another thing. I only worked for a smaller employer once in my career. They had a "rule" that if you could get insurance from a spouse's plan - you could *not* get it from work. This was challenged by a coworker who's spouse's plan charged full freight (no subsidy or discount) for spouse/children.

My DH worked mostly for smaller companies and often they gave a discount to the employee and charged full fare for family members - and the insurance was often pretty bad... fortunately for him I always had a good plan through my large employer.

 

[kcowan]

When we are down there visiting, all complain about the high cost of alcoholic beverages in Canada and blame the health care system for the higher price.

Our house wine in Vancouver is a Chilean Concha y Toro Frontera Cab Sav that is $16/1.5 liters which is under US$6 for 750 ml. I would not want to rely on that for my health care!

It is true that taxes cover health costs but those are income taxes and sales taxes in addition to excise taxes on liquor, cigarettes and gasoline. We can argue that snowbirds are not carrying their fair share because they only contribute income taxes when not in Canada.

 

[rodi]

ITA with DayLateDollarShort about how inadequate the high risk pool was in California. You had to be declined by several insurance companies before you could start the clock to be put on the waitlist for the expensive plan. If any company agreed to insure you - even if it was completely unaffordable, you did not qualify for the high risk pool. You had to use your full COBRA period before the process started.

CA is progressive in a lot of ways - but that particular program was a disaster.

 

[kcowan]

Hope you keep it. My dad's former employer basically went to a fixed medical compensation system effective 1/1/2017. So now he gets some money to buy coverage, but it won't be increasing as costs/inflation increase, and I don't think it was enough to even fully cover this year's coverage.

My former megacorp did the same thing 20 years ago, introducing an annual HSA contribution in place of 100% medical coverage. Retirees have been complaining that their portion of medical insurance costs now take over 50% of their entire pension in addition to the HSA.

 

[kcowan]

Do you mean this one? I really like it. $12.99 at BC Liquor stores.

MALBEC - FINCA LOS PRIMOS | BC Liquor Stores

Yes it is $5.40 Cdn here in PV.

Did I mention that we live on half the money here in Mexico that it costs in Vancouver. Milk is under 15% and wine is 42%. Local vodka is C$3.17/liter! We can easily afford a little increase in health care costs.

 

[SecondCor521]

Has there been any discussion of MEC in the AHCA? Does it stay, does it go, does it get modified?

 

[SecondCor521]

Has there been any discussion of MEC in the AHCA? Does it stay, does it go, does it get modified?

Found my answer in Wiki:

"Insurers are not required to offer the ten essential health benefits which include coverage for emergency, pregnancy, maternity, newborn care, mental health and substance use disorder services after December 31, 2019.[22]"

 

[MichaelB]

Found my answer in Wiki:

"Insurers are not required to offer the ten essential health benefits which include coverage for emergency, pregnancy, maternity, newborn care, mental health and substance use disorder services after December 31, 2019.[22]"

Section 134 of the W&M bill covers the elimination of actuarial value, but does not mention the elimination of essential health benefits.

 

[duckcalldan]

Do I understand correctly that the proposed tax credits are refundable, so that they would be paid directly to the insurer and would/could be more than our total federal tax liability? For my wife and I in our 50s, the tax credit would be $3500x2, plus whatever tax credit our 2 dependents would receive. This would be much larger than our anticipated federal tax bill. Up til now I felt that the ACA was much better financially for our family after all is said and done. But the above tax credit at income less than $150K would give us room for Roth conversions up to the 15% tax bracket. So it may not be as bad as originally thought. Is my logic correct?

Now we have to get AARP and other lobbyists to stop the "old folks" limit change from 3x to 5x.

 

[TreeHugger]

I am very curious what will happen in Arizona.

Without mandate it is likely that healthy people will simply wait untill they get sick. When this occurs Insurance Companies tend to loose money and pull out of the Market.

Arizona will be interesting since it already has single Insurance Company.

 

[explanade]

Now we have to get AARP and other lobbyists to stop the "old folks" limit change from 3x to 5x.

Seems like they're going to try to get this through ASAP.

While there's been a lot of opposition to many of the terms expressed, including by House members and Senators, it looks like it will be put up to a vote with minimal or no modifications.

So not sure how much lobbying influence there will be.

 

[Pilot2013]

My experience with a large employer was there was no age component in pricing - as a middle aged (older) employee with an even older husband, plus two kids - I paid the same as an employee 20 years younger than me - and his wife and 2 kids.

Smaller employers are another thing. I only worked for a smaller employer once in my career. They had a "rule" that if you could get insurance from a spouse's plan - you could *not* get it from work. This was challenged by a coworker who's spouse's plan charged full freight (no subsidy or discount) for spouse/children.

My DH worked mostly for smaller companies and often they gave a discount to the employee and charged full fare for family members - and the insurance was often pretty bad... fortunately for him I always had a good plan through my large employer.

My employer does not adjust premium for age difference. What they have done is adjust premium based on income. There is a "base" premium amount in each category (Self, Self + Spouse, Self + Family) and then an adder of a percentage as income goes above a specific amount.

Much like i have advocated that SS Tax should not end at a certain income level, I am fine with having to pay a higher HI Premium based on my income.

 

[Hamlet]

One of those things I find confusing is why so much effort is put into creating an individual insurance market that is highly segmented, pricing it with it such granularity, and allowing such easy opt-outs, while the two largest insured groups (3/4 of all population), which are much more effective at providing coverage, do just the opposite - no opt outs, one price for all. Medicare does have a little price variability, very little compared with the individual market. Both of those markets are heavily subsidized, but that doesn't affect the basic approach.

The reason our employer-based insurance and Medicare work so well is because people can't really opt out of them. I have to buy the plan that my employer offers. Likewise, Medicare is so heavily subsidized that even a perfectly healthy senior is going to sign up.

With individual plans, the healthy people are very likely to drop a plan as it becomes expensive. So it death spirals naturally, unless you have all the underwriting, segmentation, etc. The ACA has the individual mandate and the limited enrollment period (and subsidies for lower incomes) to try to force healthy people into the pool. However, it is not clear that those were going to be enough long term. Insurance companies has recommended tighter controls to the exceptions to the enrollment period and a larger individual mandate penalty. I think those fixes make sense.

Since this new plan has reduced subsidies and what appears to be a weaker penalty for going without insurance for healthy people, I expect it to death spiral quickly.

 

[scrabbler1]

The reason our employer-based insurance and Medicare work so well is because people can't really opt out of them. I have to buy the plan that my employer offers. Likewise, Medicare is so heavily subsidized that even a perfectly healthy senior is going to sign up.

With individual plans, the healthy people are very likely to drop a plan as it becomes expensive. So it death spirals naturally, unless you have all the underwriting, segmentation, etc. The ACA has the individual mandate and the limited enrollment period (and subsidies for lower incomes) to try to force healthy people into the pool. However, it is not clear that those were going to be enough long term. Insurance companies has recommended tighter controls to the exceptions to the enrollment period and a larger individual mandate penalty. I think those fixes make sense.

Since this new plan has reduced subsidies and what appears to be a weaker penalty for going without insurance for healthy people, I expect it to death spiral quickly.

+100. Also remember that one reason someone should buy (health) insurance, even if healthy, is that they may become sick at some point. Insurance is to protect someone against the possibility of an unfortunate event happening.

 

[zinger1457]

Do I understand correctly that the proposed tax credits are refundable, so that they would be paid directly to the insurer and would/could be more than our total federal tax liability? For my wife and I in our 50s, the tax credit would be $3500x2, plus whatever tax credit our 2 dependents would receive.

Yes, in the current proposal it is a refundable tax credit and it's one of the reasons why some in Congress who want to repeal ACA are against it, they say it's not much different than the current ACA subsidies.

 

[Hamlet]

+100. Also remember that one reason someone should buy (health) insurance, even if healthy, is that they may become sick at some point. Insurance is to protect someone against the possibility of an unfortunate event happening.

One thing I haven't seen about the new plan is what the allowed enrollment period is. Does it have the same limited signup period as the ACA?

That is a key detail.