Current Administration vow to eliminating ACA

[Tiger8693]

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Originally Posted by Aerides Financially, yes. But I'd think that the protection for coverage for pre-existing conditions is a bigger impact for many, as it's Y/N on if you can get private non-group insurance at all.

Almost everything I have read where there is a proposal to remove ACA has a qualifier that pre-existing coverage is maintained. I guess there are some that don't, but I think that is few and far between from what I have read.

[Aerides]

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Originally Posted by Tiger8693 Almost everything I have read where there is a proposal to remove ACA has a qualifier that pre-existing coverage is maintained. I guess there are some that don't, but I think that is few and far between from what I have read.

Sure I see that too. But if the ACA is ruled unconstitutional (as the current case aims to do), until there is new law in place, there is no coverage, game over. Just proposals and promises. So, bird in the hand, etc.

[Tiger8693]

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Originally Posted by Aerides Sure I see that too. But if the ACA is ruled unconstitutional (as the current case aims to do), until there is new law in place, there is no coverage, game over. Just proposals and promises. So, bird in the hand, etc.

Agreed. But if it is unconstitutional, well, it has to be struck down. Hopefully at that point a system that is constitutional and provides for pre-existing conditions is negotiated in good faith and put in place. Fingers crossed.

[ivinsfan]

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Originally Posted by Poopycat I wish that some of the politicians who were floating the Medicare buy-in option for age 55+ would have gotten more traction. It would have allowed people who wanted or needed insurance to purchase Medicare for a reasonable cost. Seems like it would have been a win-win situation for everybody. Many in the 55-65 age range who want to retire early or just can’t find another job after being laid off could buy into Medicare so they could be insured, and avoid the exorbitant costs of the individual market. The program would be optional so if they had a better option (currently employed, covered under spouse’s plan), they wouldn’t have to participate. It wouldn’t hurt the government, and may actually help to have younger and potentially healthier people in the Medicare pool, and they would be paying into the program so there shouldn’t be a giant cost burden. And to your point, if you take some of the older and potentially “less healthy” people out of the private insurance pool, that should theoretically bring down the premium costs for the others in the individual market. Seems so simple to me. My understanding is Obama had wanted to lower the Medicare age to 55 as part of the ACA (not a buy-in, just lower the age), but Joseph Lieberman, the CT senator, was dead set against it for some reason. Man, I wish that had gone through. Would have solved a bunch of my concerns...

It wasn't just one senator, the medical people don't want Medicare for all or anything resembling it. The pay schedule is so low it gives people medical care by costing doctors and hospitals big bucks..

[jimbee]

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Originally Posted by Golden sunsets What do you mean by nope? If by nope you mean there are some who pay full boat, then you are correct.

Yes, that is what I meant.

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Originally Posted by Golden sunsets But the vast majority of Medicare recipients are heavily subsidized. Only those with modified adjusted gross incomes above $500,000/yr, (single), $750,000 (married) receive no subsidy.

I agree, and I stated that in post #20 of this thread.

[eytonxav]

I never had to utilize ACA being on my employers plan after I retired and before going on medicare. However, DD has been on ACA, and what struck me is how ACA changed over the years. The big negatives are the networks are very narrow so you cannot go the hospitals and doctors you prefer, and co-pays/co-insurance and out of pocket maxes make it pricy for what you get. I guess for retirees that are pre-medicare without employer coverage, it would be nice to have a more stripped down and reasonably priced version that covers pre-existing conditions.

[gauss]

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Originally Posted by Tiger8693 Almost everything I have read where there is a proposal to remove ACA has a qualifier that pre-existing coverage is maintained. I guess there are some that don't, but I think that is few and far between from what I have read.

By "qualifier that pre-existing coverage is maintained", are you suggesting that medical underwriting (pricing individual premiums based on medical history) will continue to be banned as is currently done under ACA?

"Shall-issue" coverage for pre-existing conditions is very different than community rating.

Oh and by the way, in addition to ACA, community rating is what is present in virtually all group (employer) health plans.

I am hoping that everyone who is calling for a "replacement" to ACA understands the difference in these two concepts.

-gauss

[ivinsfan]

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Originally Posted by gauss By "qualifier that pre-existing coverage is maintained", are you suggesting that medical underwriting (pricing individual premiums based on medical history) will continue to be banned as is currently done under ACA? "Shall-issue" coverage for pre-existing conditions is very different than community rating. Oh and by the way, in addition to ACA, community rating is what is present in virtually all group (employer) health plans. I am hoping that everyone who is calling for a "replacement" to ACA understands the difference in these two concepts. -gauss

Nope all the masses understand it that they get it "free" from their jobs or the government will give you big credits if you keep your income low. The very definition of narrow minded.

[Tiger8693]

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Originally Posted by gauss By "qualifier that pre-existing coverage is maintained", are you suggesting that medical underwriting (pricing individual premiums based on medical history) will continue to be banned as is currently done under ACA? "Shall-issue" coverage for pre-existing conditions is very different than community rating. Oh and by the way, in addition to ACA, community rating is what is present in virtually all group (employer) health plans. I am hoping that everyone who is calling for a "replacement" to ACA understands the difference in these two concepts. -gauss

What I am suggesting is that people would not be denied coverage due to pre-existing condition, nothing more. Not trying to solve the overall HI problem. That has already been tried, and failed.

[Aerides]

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Originally Posted by DFW_M5 The big negatives are the networks are very narrow so you cannot go the hospitals and doctors you prefer, and co-pays/co-insurance and out of pocket maxes make it pricy for what you get. I guess for retirees that are pre-medicare without employer coverage, it would be nice to have a more stripped down and reasonably priced version that covers pre-existing conditions.

Unfortunately, it really varies by state and even county. I've heard and read the stories about areas with one plan only available, or one provider. But where I live I have a choice of several providers, dozens of plans at all levels. I had to switch docs when I started but I've been very pleased with my new choices, as as DH. I can definitely say if I can keep this plan for 15 years I'll be very happy.

[Rianne]

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Originally Posted by Aerides Unfortunately, it really varies by state and even county. I've heard and read the stories about areas with one plan only available, or one provider. But where I live I have a choice of several providers, dozens of plans at all levels. I had to switch docs when I started but I've been very pleased with my new choices, as as DH. I can definitely say if I can keep this plan for 15 years I'll be very happy.

This is the problem. We have great HI in some states, even counties within those states are different. And terrible HC in other states/counties. The question is should all states be equal and offer the same benefits to everyone.

Would I go to a small town, local hospital that serves a limited population? Or would I go to Northwestern, U of Chicago, Rush...for the best surgeons, best HC? What could I afford? And how important is the procedure to my future health? Some people are happy to have an MD in their area who will see them. I check background, resume, med school attended and even want to know how many surgeries or procedures that Doc has done.

Medicare would unify our care to an extent. To those Docs that accept Medicare. And for those who can afford the best will pay for the best.

We're a divided country on this issue.

[gauss]

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Originally Posted by Tiger8693 What I am suggesting is that people would not be denied coverage due to pre-existing condition, nothing more. Not trying to solve the overall HI problem. That has already been tried, and failed.

Would you be okay if your premiums went up by a factor of 5 or 10 after you were referred to a cardiologist for the first time, came down with cancer, or contracted a cornoavirus? Surely the insurance company would want to price for this increased risk if it were to occur. Especially if their competitors are allowed to.

These are the scenarios that concern me. I was able to ER in that I could have somewhat predictable healthcare costs after leaving the employer group health insurance pool where premiums were based on the entire pool of employees -- not each individual separately.

That being said, I am not opposed to some differential pricing for continuing current behavior that is risky (ie tobacco use, obesity, untreated hypertension) and that the individual has some degree of control over.

Respectfully,
-gauss

[eytonxav]

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Originally Posted by Aerides Unfortunately, it really varies by state and even county. I've heard and read the stories about areas with one plan only available, or one provider. But where I live I have a choice of several providers, dozens of plans at all levels. I had to switch docs when I started but I've been very pleased with my new choices, as as DH. I can definitely say if I can keep this plan for 15 years I'll be very happy.

What I described is what happened in the DFW metroplex in Texas. While it was good coverage and network for about two years, the network got progressively narrower and the coverage more expensive each year thereafter. There has always been multiple insurers, but they all were lousy, even from large ones like Blue Cross. Texas has a problem with healthcare due to so many uninsured and illegals and their care ends up being subsidized by those who can pay and also too few doctors.

[Poopycat]

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Originally Posted by RetiredAt55.5 Actually, there is one politician (still in the race) that announced on April 9th his proposal for people age 60+ the option to buy into Medicare. This candidate said "And to be clear — these are priorities now, but they will be my program ...." That's as much as I think I can say without introducing politics. You can google it for more information.

Yes, I’m aware of that proposal. A candidate from a few years ago, again won’t say who, had proposed 50 as the age. So 60 is better than 65 but not as bold as other proposals.

[Poopycat]

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Originally Posted by Eucerin I believe you. The ideas for 50+, 55+ and 60+ are definitely there and have been voiced too but it's not going anywhere (not to get into any politics)

It could. Hard to discuss this topic without venturing into politics. Depends on makeup of the executive and legislative branches.

[Poopycat]

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Originally Posted by ivinsfan It wasn't just one senator, the medical people don't want Medicare for all or anything resembling it. The pay schedule is so low it gives people medical care by costing doctors and hospitals big bucks..

Wasn’t suggesting Medicare for All. I specifically said a buy-in option for 55+. We won’t get universal coverage in this country because there are too many powerful insurance lobbyists and medical groups out there who have spent billions over decades convincing us of the evils of “socialized” medicine.

[ivinsfan]

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Originally Posted by Poopycat Wasn’t suggesting Medicare for All. I specifically said a buy-in option for 55+. We won’t get universal coverage in this country because there are too many powerful insurance lobbyists and medical groups out there who have spent billions over decades convincing us of the evils of “socialized” medicine.

55 and over doesn't make a difference this age starts to require more health care at more expense that's the way it works. It fact it might be less costly in total to do Medicare for all, but it won't happen.

[Lakewood90712]

I think Porky is looking at this thread now.

[copyright1997reloaded]

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Originally Posted by Poopycat Wasn’t suggesting Medicare for All. I specifically said a buy-in option for 55+. We won’t get universal coverage in this country because there are too many powerful insurance lobbyists and medical groups out there who have spent billions over decades convincing us of the evils of “socialized” medicine.

And there are many who don't understand the economics of coverage and the impact of adverse selection, which is why there are areas in the country with only a single plan.

Let's assume that there is a buy-in OPTION for 55+, priced based on actual cost numbers (no subsidies). Using 2018 data:

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According to the most recent data available from the CMS, national healthcare expenditure (NHE) grew 4.6% to $3.6 trillion in 2018. That's $11,172 per person.

source: https://www.investopedia.com/article...-americans.asp. If there were similar increases in 2019/2020, we would now be at 12,223/person in 2020. On a monthly basis, that is $1018.

According to this article, the nation wide average unsubsidized ACA plan cost is:

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Premiums for individual coverage averaged $440 per month

. Uplift that at the same rate for 2020, and we would have $460/month.

So assuming the ability to opt in @ $1018/month vs. an ACA plan at $460/month, so are the likely people to do so?

Answer: Those who are more at risk and need the assurance of the more robust plan.

Now, a counter argument is that the $1018 number is high - because it includes older / sicker people than a 55 to 65 segment would provide. So, the numbers could be considerably closer? Does anyone have any estimates /sources of information for this?

[REWahoo]

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Originally Posted by Lakewood90712 I think Porky is looking at this thread now.

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