Whatcha gonna do if ACA goes away?

[FLSUnFIRE]

Rough back of envelope based off a few internet searches shows US Presidential election voter turn out of about 158M (and non-presidential substantially less) and current ACA marketplace enrollments are about 15.5M so ~10% of the max turn out which most politicians would pay attention to. Not all would vote but if they lost (or felt they would lose) coverage they sure might! That's why I'm not that worried... nevermind the entrenched interests/lobbying already alluded to in this thread. I'm pleasantly surprised this has stayed non-partisan and civil.



Marketplace enrollment has been going up the last few years too: https://www.statista.com/statistics/1280656/number-of-us-aca-related-enrollments/

 

[pb4uski]

I think the ACA also impacted the growth of the gig economy. There are a lot of gig workers that buy their own insurance and the ACA benefits them as well. Just my theory but I would not be surprised if there are more users of ACA because of ACA. That is, the ACA reduced their perceived risk in taking the leap from traditional employment, so they leapt and now are taking advantage of ACA.

ACA subsidies are pretty modest... according to the CBO $92 billion in 2023 and increasing to $122 bllion in 2033 and a small fraction of total federal subsidies for health insurance.

 

[FLSUnFIRE]

ACA subsidies are pretty modest... according to the CBO $92 billion in 2023 and increasing to $122 bllion in 2033 and a small fraction of total federal subsidies for health insurance.

It's more than just the subsidies. For me as a pretty recently FIREd person ACA definitely added to my confidence pulling the trigger but I was planning for ER long before the ACA. While the subsidies are a huge benefit, I still plan for the full cost of my plan and track it as an expense and treat the subsidy as a negative tax on the revenue side. Two big advantages to me was the confidence that I could get insurance without too much pain or rejection if I were to be diagnosed with something chronic and the ease of shopping/comparison that the marketplace allowed me.

 

[The Cosmic Avenger]

Rough back of envelope based off a few internet searches shows US Presidential election voter turn out of about 158M (and non-presidential substantially less) and current ACA marketplace enrollments are about 15.5M so ~10% of the max turn out which most politicians would pay attention to. Not all would vote but if they lost (or felt they would lose) coverage they sure might! That's why I'm not that worried... nevermind the entrenched interests/lobbying already alluded to in this thread. I'm pleasantly surprised this has stayed non-partisan and civil.



Marketplace enrollment has been going up the last few years too: https://www.statista.com/statistics/1280656/number-of-us-aca-related-enrollments/

Well, don't forget, a lot of ACA provisions affect all health insurance, not just marketplace plans, like not dropping or charging more due to pre-existing conditions, or offering coverage for adult children until 26, so a lot more people would be affected than 15.5M, although it's hard to say exactly how many.

 

[The Cosmic Avenger]

Well, don't forget, a lot of ACA provisions affect all health insurance, not just marketplace plans, like not dropping or charging more due to pre-existing conditions, or offering coverage for adult children until 26, so a lot more people would be affected than 15.5M, although it's hard to say exactly how many.

In case anyone's curious, according to the Kaiser Foundation, "KFF has estimated that in 2018 about 54 million non-elderly adults in the U.S. (27%) had “declinable” pre-existing conditions that would have made them “uninsurable” in the pre-ACA individual health insurance market."

 

[Fermion]

In case anyone's curious, according to the Kaiser Foundation, "KFF has estimated that in 2018 about 54 million non-elderly adults in the U.S. (27%) had “declinable” pre-existing conditions that would have made them “uninsurable” in the pre-ACA individual health insurance market."

And that is the rub, the reason I think that they can't just yank the ACA away totally. 54 million people suddenly told they are not insurable is just too many votes.

It isn't even about affordability, or making sure you have enough to retire without ACA. If you are covered now and they removed the ACA, there is a possibility you could not get insurance for any price if you have a pre existing condition that is serious.

 

[GenXguy]

Well, don't forget, a lot of ACA provisions affect all health insurance, not just marketplace plans, like not dropping or charging more due to pre-existing conditions, or offering coverage for adult children until 26, so a lot more people would be affected than 15.5M, although it's hard to say exactly how many.

You forgot about another 15 Million people on Expanded Medicaid. I had already mentioned that the Medicaid Expansion is part of the ACA as well. So if the ACA goes away at the end of 2025 or whenever, those people are left uncovered as well, not just insurance plans

ACA should last the rest of this year and next at least, but it could easily be reformed, cut, broken up, or replaced with something much less effective like the past acts that didn't pass both chambers of Congress by the thinnest of margins, per my earlier posts.

 

[Fermion]

What is the reason you think 2025 is such a key year? Because of regime change?

 

[GenXguy]

What is the reason you think 2025 is such a key year? Because of regime change?

It could be. I don't want to get political in any partisan sense, though. I would actually hope it would last beyond that. I just feel it's safest to that point - to the end of that year.

 

[aaronc879]

I think there is zero chance of the ACA being taken away unless it is replaced by something like Universal Health Care, Medicare for All type of thing. I think ACA will be here for at least a couple decades. I'm 20 years away from current Medicare age and I am operating under the assumption that ACA will be there or something will be there were my costs are even less than they are now.

 

[ShokWaveRider]

As far as it goes, never say never when it comes to things that are controlled by the powers that be. A lot of things have happened in the last 8 - 10 years that we thought never would. Not only here but in Europe too.

 

[ivinsfan]

ACA subsidies are pretty modest... according to the CBO $92 billion in 2023 and increasing to $122 bllion in 2033 and a small fraction of total federal subsidies for health insurance.

Expanded Medicaid can be partially counted as ACA costs ..thou not reflected the same way on tax forms.

 

[GenXguy]

I think there is zero chance of the ACA being taken away unless it is replaced by something like Universal Health Care, Medicare for All type of thing. I think ACA will be here for at least a couple decades. I'm 20 years away from current Medicare age and I am operating under the assumption that ACA will be there or something will be there were my costs are even less than they are now.

It's a long shot. I'll cross my fingers for you.

 

[MichaelB]

I would go with two years. It should be safe through the end of 2025. I would bet on that.

There have been proposals to change it which included a change in the subsidies that passed the House in the past:

American Health Care Act

https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017

and the American Rescue Plan Act made changes that passed:

https://en.wikipedia.org/wiki/American_Rescue_Plan_Act_of_2021

The AHCA is a good example of an effort to repeal, and I should have acknowledged that in my post.

I’d comment on it further but to do so would open the door to a partisan discussion, which we all do not want. The bill was not considered in the Senate.

 

[sengsational]

It seems reasonable to assume that if there is any changes to the laws in this realm, that people currently covered would be able to continue being covered without underwriting. Those that are getting PTC might need to pay more, but I'd guess there would be some accomodation so this big group didn't all throw up their hands and walk away from health insurance, only to show up as a non-revenue patient at the ER. Ain't nobody that wants that.

 

[Fermion]

It seems reasonable to assume that if there is any changes to the laws in this realm, that people currently covered would be able to continue being covered without underwriting. Those that are getting PTC might need to pay more, but I'd guess there would be some accomodation so this big group didn't all throw up their hands and walk away from health insurance, only to show up as a non-revenue patient at the ER. Ain't nobody that wants that.

I don't think it is that easy. How are you going to force the insurance companies to continue coverage of someone without underwriting if the ACA goes away? Even now they constantly shift and drop out of certain market areas, so a new company has to accept people with pre existing conditions and no underwriting? And do this without the benefit of ACA subsidies and guarantees?

If some of this did happen by whatever *slight* chance, there are a few states which probably would continue with their own version of ACA. I imagine Washington state is one of them since they seem to already be pushing this thing called Cascade plans, which are additional subsidy on top of the ACA subsidy. I didn't sign up for that this year but they keep emailing me saying "Are you sure you don't want a Cascade plan?". I am only paying like $2 a month...I feel like I should pay *something*.

 

[Poopycat]

Concerns about ACA going away?

I have been on the fence about retiring for about 2 years now. I might have pulled the trigger late last year but to my surprise my company agreed to let me work remotely as long as I return occasionally. My short term plan is to visit different areas of interest in 4-week stretches to see if I would want to retire in one of those places, then return to my current location for a week before heading out again. I won’t sell my condo since I’ll be returning occasionally; if and when I find the right location then I’ll sell and move. These trips are expensive, especially while maintaining a residence, I figured I should keep working to subsidize the cost.

I just found out that my boss is leaving and, while I can still do the remote work thing, I worry about who will take over. I do not want to be stuck with a rotten boss, I’ve had that before too many times and I won’t go through it again. While I think I should still try to get through to November so I can get some additional vested stock grants (probably and extra $16K worth…not a ton of money but it’s mine), I think it will be time for a change.

The reason this post is in the Health forum: other than the cost of my visits to other cities, my big concern is health insurance. I know there is ACA, not ideal but I’ll take it.

[mod edit]

For those of you who rely on ACA, how worried are you about it possibly going away in 2025 or 2026? What would you do for coverage? If you were me - single, still working, age 53/almost 54 - would a possible ACA repeal keep you from retiring?

While it’s fair to say that I’m a worrier and that I should just retire already (my last asset review, two weeks ago, was a net worth of $4.85M, which includes a condo that I estimate would net $500K after closing costs; it doesn’t take into account my taxes which could be high this year), the fear of not having good health insurance worries me. I had a health scare early this year, which has reinforced my concerns about not having good insurance.

Thoughts are welcome, thanks.

 

[Calico]

The same question was addressed in this thread last month. The OP in this thread was also 53 years old and thinking about retiring.

https://www.early-retirement.org/forums/f38/whatcha-gonna-do-if-aca-goes-away-121046.html

 

[Poopycat]

The same question was addressed in this thread last month. The OP in this thread was also 53 years old and thinking about retiring.

https://www.early-retirement.org/forums/f38/whatcha-gonna-do-if-aca-goes-away-121046.html

Ok thank you

 

[SecondCor521]

I am almost 55, retired at 46, been on the ACA since retiring.

I worry zero. There are a series of events that would have to occur that I consider extraordinarily unlikely. A historical fact that I consider relevant is that there were a series of votes in about 2018 attempting to repeal and replace the ACA. They all failed because even among those who don't like the ACA, there isn't enough agreement on what to replace it with.

Practically speaking, with your net worth and age, you will be able to afford health insurance. And if you can't afford health insurance or your medical bills, then any illness that expensive will probably shorten your lifespan to such an extreme degree that you will "succeed" in your retirement by dying in your 60s before you spend all your money fighting it. Obviously not what anyone wants to happen and not a cheery thought, but as a logical matter, if true, then the potential lack of availability of health insurance should not stop you from retiring.

 

[pb4uski]

ACA has become very popular and IMO will be around for a long time. Besides, with a $4.85m portfolio you could afford unsubsidized health insurance if you have to.

Come on in... the water's fine.

 

[jim584672]

Almost 5 million, I think you will squeeze by one way or another.

 

[dmpi]

What did people do before ACA? With almost five million I'm sure you can handle unsubsidized health insurance.

 

[Montecfo]

There were more issues than a lack of subsidy. There was a lack of access if you had pre-existing conditions. Medical underwriting.

 

[Fermion]

I worry more about getting Doritos stuck in between my teeth than ACA going away.

You have at least 4 million invested. That is $200k a year even if you just put it in 5% treasuries. A high deductible health plan is going to be less than 10% of that, probably less than 5%. If you had high medical expenses one year, well, they are deductible, so you would owe less tax that year.