ACA Federal Marketplace updates

[MRG]

Thanks for a very reasonable explanation.
MRG

 

[meierlde]

Right or wrong it is nothing specific to ACA. All insurance having tobacco usage surcharges but they don't test for smoking other substances. ACA was somewhat patterned after existing group health plans which typically include a tobacco usage question. In group plans they would probably deny claims for things found to be tobacco related. In the individual market they would cancel your policy. But why would you be using nicotine gum unless you were a smoker.

Government declared war on tobacco almost 40 years ago, obesity is just now getting attention so it may get a hit in the future.

Maybe it would be better to put a health tax on the actual tobacco product at point of sale rather than penalties on the insurance premium.

That has already been done, the Tobacco settlement effectively imposed a tax on Tobacco. This is the source of funding states used to issue some bonds. Its also why the price is so much higher than it was relative to inflation.

Note that the Texas High Risk pool used to have 2 sets of rates one for smokers and one for non smokers. Which is an example of what was cited above.

 

[frank]

Note that the Texas High Risk pool used to have 2 sets of rates one for smokers and one for non smokers. Which is an example of what was cited above

most states have a health insurance surcharge for smokers or people using nicotine. but under ppaca a lot of the states do not have the surcharge.

But why would you be using nicotine gum unless you were a smoker.

this is the same as asking why would anyone use energy drinks or drink espresso. they want the energy push.

 

[ShokWaveRider]

So simple to solve and not really worth the extensive discussion.

1) Give it up
2) Do not give it up, smell bad, pay more, live a shorter life.

IMHO This should apply to Medicare also. Smokers should pay more as they are a far greater burden on the system. Seems straight forward to me.

 

[ziggy29]

IMHO This should apply to Medicare also. Smokers should pay more as they are a far greater burden on the system. Seems straight forward to me.

Well, I don't want this to stray too far into ideology of things -- this isn't the place for it -- but I would say that if we're going to go down this road, we have to realize that "healthy" lifestyles put a greater burden on Social Security and public pensions because they are living several years longer on average, thus collecting more benefits. So shouldn't they receive lower benefits to compensate for it?

Then, one can also say, "why single out smoking? Why not target alcohol, junk foods, supersized portions, et cetera?" Pretty soon we'd have a bureaucracy calculating the "public cost" of everything we do and don't do.

We need to be really careful about opening Pandora's Box, as applying principles (like "their lifestyles are costing me money!") consistently can create a *lot* of unintended consequences. This is why, for now, we should just keep it simple and perhaps "health care surcharges" for using unhealthy products might be better levied on the products themselves (at some point in the future). But for now, we deal with what we actually have, and how we prepare for it.

 

[Mulligan]

Right or wrong it is nothing specific to ACA. All insurance having tobacco usage surcharges but they don't test for smoking other substances. ACA was somewhat patterned after existing group health plans which typically include a tobacco usage question. In group plans they would probably deny claims for things found to be tobacco related. In the individual market they would cancel your policy. But why would you be using nicotine gum unless you were a smoker.

Government declared war on tobacco almost 40 years ago, obesity is just now getting attention so it may get a hit in the future.

Maybe it would be better to put a health tax on the actual tobacco product at point of sale rather than penalties on the insurance premium.

Although I have never read this anywhere, the real reason I believe that they levy increase premium costs on nicotine gum/mint users has nothing to do with the nicotine at all as its health effects are very negligible. It has to do with the fact that the vast majority of users fall back off the wagon and smoke again. They do not want a loophole of people saying they were using gum/mints when in fact they were smoking.

 

[gauss]

...

Then, one can also say, "why single out smoking? Why not target alcohol, junk foods, supersized portions, et cetera?" Pretty soon we'd have a bureaucracy calculating the "public cost" of everything we do and don't do.

Sounds like a new revenue stream/specialty for the actuaries.

-gauss

 

[frank]

ziggy29: couldn't have said it better myself.

 

[sheehs1]

I have a problem with disenfranchising one segment of society and not the others whose lifestyle choices or habits (if you will) pose a commiserate cost. Both of my parents smoked. One died at age 76 and one at age 80. Their medical cost the last year or so of their lives was not anywhere near the cost of a lifetime alcoholic particularly if you include the deaths due to drunk drivers, a diabetic who became diabetic due to being grossly overweight, or a pain med junkie with a thousand or more a month "need". Everyone is suppose to get health care. Can you imagine the medical cost of a heroin addict?
How about Aids that was contracted from a lifestyle choice (not in all cases) ?
To single out tobacco use IMHO is just not right.

And to think some of those making up our current laws were raised in the 50's, 60's and 70's and were so against the establishment.

Peace, love your brother and all that! Ha!

 

[meierlde]

Well, I don't want this to stray too far into ideology of things -- this isn't the place for it -- but I would say that if we're going to go down this road, we have to realize that "healthy" lifestyles put a greater burden on Social Security and public pensions because they are living several years longer on average, thus collecting more benefits. So shouldn't they receive lower benefits to compensate for it?

Then, one can also say, "why single out smoking? Why not target alcohol, junk foods, supersized portions, et cetera?" Pretty soon we'd have a bureaucracy calculating the "public cost" of everything we do and don't do.

We need to be really careful about opening Pandora's Box, as applying principles (like "their lifestyles are costing me money!") consistently can create a *lot* of unintended consequences. This is why, for now, we should just keep it simple and perhaps "health care surcharges" for using unhealthy products might be better levied on the products themselves (at some point in the future). But for now, we deal with what we actually have, and how we prepare for it.

As I understand it if you apply for an annunity, and are found to be unhealthy, you can get more per month, sort of the opposite of the old insurance physical, since they would expect you to die sooner.

 

[ERhoosier]

Let's try to keep Porky at bay & stay OT. I have no doubt there will be other chances to comment on future efforts from both political parties to modify ACA in the coming months/years. But as Oct 1 fast approaches I think it's still useful to maintain a thread to stay abreast of Marketplace updates.

Agree or not, the smoking surcharge is currently an optional (not required) part of ACA. States can choose NOT to use it to set Exchange premiums (e.g. VT, RI, MA). And as I understand it there would be no smoking surcharge on Medicaid recipients since it charges no premiums.

 

[bUU]

Let's try to keep Porky at bay & stay OT. As Oct 1 fast approaches, I think it's still useful to have a thread to stay abreast of Marketplace updates.

Given how often the discussion veers toward Porky, it would be best to either [a] just allow partisan political comments, or for moderators to simply delete any and all positive or negative appraisals posted. The latter would be more "useful". If this is truly to be a news update thread, and comments for or against the program not permitted, then such bias should simply be eliminated, excised, to cut off the progression of such conversation. The repeated process of allowing some appraisal, and then getting all concerned about bringing Porky on, and back and forth and back, almost seems to add more meta-discussion to the thread than there is partisan discussion!

Agree or not, the smoking surcharge is an optional part of ACA but not a requirement. States can choose NOT to use it to set HI premiums (e.g. VT, RI, MA).

I wasn't aware that MA was on that list. Thanks.

 

[jflynn4]

So, without dropping into the political side of things, what are the odds of the ACA actually taking effect on January 1st as scheduled and, in general, as currently written with regards to the guaranteed coverage and subsidies? If, somehow, it goes unfounded, will other parts. (I.e., guaranteed coverage) still go into effect?

 

[MichaelB]

Given how often the discussion veers toward Porky, it would be best to either [a] just allow partisan political comments, or for moderators to simply delete any and all positive or negative appraisals posted. The latter would be more "useful". If this is truly to be a news update thread, and comments for or against the program not permitted, then such bias should simply be eliminated, excised, to cut off the progression of such conversation. The repeated process of allowing some appraisal, and then getting all concerned about bringing Porky on, and back and forth and back, almost seems to add more meta-discussion to the thread than there is partisan discussion!

Alt A is not in keeping with community posting guidelines, and Alt B is way too much work. How about Alt C, which is we discuss implementation of the law and how it affects us.

So, without dropping into the political side of things, what are the odds of the ACA actually taking effect on January 1st as scheduled and, in general, as currently written with regards to the guaranteed coverage and subsidies? If, somehow, it goes unfounded, will other parts. (I.e., guaranteed coverage) still go into effect?

So, a discussion about not implementing a law, but not dipping into politics? I don't see how that can happen, but in any case it is not the topic of this thread. If you feel it can be done please feel free to start that thread topic. Probably best in another sub-forum, though, such as FIRE Related Political Topics - Early Retirement & Financial Independence Community

 

[Bestwifeever]

....

So, a discussion about not implementing a law, but not dipping into politics? I don't see how that can happen, but in any case it is not the topic of this thread. If you feel it can be done please feel free to start that thread topic. Probably best in another sub-forum, though, such as FIRE Related Political Topics - Early Retirement & Financial Independence Community

Yes, please start a new thread elsewhere. This one is so helpful for planning as states get their exchanges up and things get clarified, it would be a disservice to the people here if it were to be steered into theoretical speculation of what political partisanship oratory might happen in Congress.

 

[jflynn4]

I can understand why you'd say that but, given all of the changes that have already been made in terms of timing, etc., just wondering what happens if, for example, we sign up thru the exchanges on October 1 but then the subsidies aren't approved thru the budget process. Do we think that the ACA will still offer the guaranteed coverage or will that be contingent on the subsidy piece?

 

[Bestwifeever]

I can understand why you'd say that but, given all of the changes that have already been made in terms of timing, etc., just wondering what happens if, for example, we sign up thru the exchanges on October 1 but then the subsidies aren't approved thru the budget process. Do we think that the ACA will still offer the guaranteed coverage or will that be contingent on the subsidy piece?

I think those possibilities could be narrowly addressed in a different thread; if something actually happened, it would be appropriate here, but not until it was being implemented (the focus of this thread). I.e., something that might happen vs. something that has been put into motion.

 

[Tandemlovers]

I think those possibilities could be narrowly addressed in a different thread; if something actually happened, it would be appropriate here, but not until it was being implemented (the focus of this thread). I.e., something that might happen vs. something that has been put into motion.

+1

Please, let's keep this thread open!

I am a daily, faithful reader of this forum, and of this discussion in particular, since the implementation
of the health care act will dovetail with my husband's decision to take a break from work come January.

I really, really appreciate the efforts of the moderators to keep the discussion courteous!

Martha

 

[RitaR551]

I'm not sure this belongs in this thread or another dealing with ACA and its impact on jobs and Clinics. This article was in our local news today. Cleveland Clinic is a big employer in the area and one of two "go to" places for specialty care.
Looks like there will be a large number of newly retired.



"Clinic Cuts: Cleveland Clinic slashes budget, layoffs loom Posted: Sep 18 2013 10:03 AM EDT Updated: Sep 18 2013 5:24 PM EDT CLEVELAND, OH (WOIO) - The Cleveland Clinic confirms they will be cutting a total of $330M from their 2014 budget. A Clinic spokesperson tells 19 Action News there will be reduction in the workforce including early retirements, layoffs and vacant positions left unfilled. No hard number will be known until late October. The Clinic released the following statement: "To prepare for healthcare reform, Cleveland Clinic is transforming the way care is delivered to patients. Over the past several years, we have had an ongoing focus on driving efficiencies, lowering costs, reducing duplication in services and enhancing quality to make healthcare affordable to patients. Although we have made progress, we need to further reduce costs to the organization by $330 million in 2014. We are carefully evaluating all aspects of our system to accomplish this. Some of the initiatives include offering early retirement to 3,000 eligible employees, reducing operational costs, stricter review of filling vacant positions, and lastly workforce reductions. Through these changing times, we are focused on providing the highest quality of care to our patients in the most efficient and cost-effective manner."

 

[bUU]

The Cleveland Clinic relies heavily on donations. If there is an influx of new donations, perhaps the curtailing of services can be reversed. It is troubling to see something relying on the variability of donations for something that is so essential to so many people.

 

[travelover]

I'm not sure this belongs in this thread or another dealing with ACA and its impact on jobs and Clinics. This article was in our local news today. Cleveland Clinic is a big employer in the area and one of two "go to" places for specialty care.
Looks like there will be a large number of newly retired.



"Clinic Cuts: Cleveland Clinic slashes budget, layoffs loom Posted: Sep 18 2013 10:03 AM EDT Updated: Sep 18 2013 5:24 PM EDT CLEVELAND, OH (WOIO) - The Cleveland Clinic confirms they will be cutting a total of $330M from their 2014 budget. A Clinic spokesperson tells 19 Action News there will be reduction in the workforce including early retirements, layoffs and vacant positions left unfilled. No hard number will be known until late October. The Clinic released the following statement: "To prepare for healthcare reform, Cleveland Clinic is transforming the way care is delivered to patients. Over the past several years, we have had an ongoing focus on driving efficiencies, lowering costs, reducing duplication in services and enhancing quality to make healthcare affordable to patients. Although we have made progress, we need to further reduce costs to the organization by $330 million in 2014. We are carefully evaluating all aspects of our system to accomplish this. Some of the initiatives include offering early retirement to 3,000 eligible employees, reducing operational costs, stricter review of filling vacant positions, and lastly workforce reductions. Through these changing times, we are focused on providing the highest quality of care to our patients in the most efficient and cost-effective manner."

9 Statistics on Executive Compensation at Cleveland Clinic

Cleveland Clinic recently released its 225-page Form 990 for fiscal year 2011, the most recent data available. Here are the 10 Cleveland Clinic executives and physicians who earned at least $1 million in FY 2011.

• Delos Cosgrove, MD, president and CEO: $2.56 million
• Joseph Hahn, MD, chief of staff: $1.28 million
• Marc Harrison, MD, CEO of Cleveland Clinic Abu Dhabi: $1.31 million
• Bruce Lytle, MD, chair of the Heart and Vascular Institute: $1.34 million
• John Costin, MD, chair of Cleveland Clinic Lorain: $4.04 million
• Victor Fazio, MD, former chair of colorectal surgery: $1.42 million
• Andrew Fishleder, MD, former CEO of Cleveland Clinic Abu Dhabi: $3.30 million
• Constantine Mavroudis, MD, former chair of pediatrics and congenital heart surgery: $1.62 million
• Daniel Martin, MD, chair of ophthalmology: $1.35 million

 

[Calico]

+1

Please, let's keep this thread open!

I am a daily, faithful reader of this forum, and of this discussion in particular, since the implementation
of the health care act will dovetail with my husband's decision to take a break from work come January.

I really, really appreciate the efforts of the moderators to keep the discussion courteous!

Martha

+100

I too want to thank the moderators for their hard work. This thread is one of the most useful, informative ones on the board, and it would be a real shame to see it close for any reason.

 

[RitaR551]

9 Statistics on Executive Compensation at Cleveland Clinic

Wow. I'm speechless.

 

[travelover]

Wow. I'm speechless.

....we need to further reduce costs to the organization by $330 million in 2014. We are carefully evaluating all aspects of our system to accomplish this.

Well maybe not all.

 

[ERhoosier]

FWIW- In my recent travels I've noticed that CC is not alone as a major referral HC system making sizable cuts. Only time will tell how this affects access regardless of whether or not one gets their HI via Exchange.