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

[jim584672]

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Originally Posted by photoguy Finally it's not clear what is happening with cost sharing plans and max out of pocket limits. Right now these can be very advantageous IF you stay under 200% of FPL.

Silver CSRs are gone:

Subtitle D—Patient Relief and Health Insurance Market Stability
SEC. 131. REPEAL OF COST-SHARING SUBSIDY.
(a) IN GENERAL .—Section 1402 of the Patient Protection and Affordable Care Act is repealed.
(b) EFFECTIVE DATE .—The repeal made by sub section (a) shall apply to cost-sharing reductions (and payments to issuers for such reductions) for plan years beginning after December 31, 2019.

[GTFan]

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Originally Posted by daylatedollarshort We would lose about $10K in subsidies. And with a pricing band change of 5 to 1 instead of 3 to 1, our premiums would increase over $13K a year.

This is the real problem - premiums will skyrocket and obliterate the $7-8k in credits that folks here will get. And it can be way more than 5:1 given that states can decide whatever they want (e.g. eliminate ratios altogether).

Assuming there's even a market left when the 30% surcharge for new insurance means that anyone healthy will simply not carry insurance until they need it. This is a recipe for a death spiral.

[photoguy]

@DayLateDollarShort -- thanks for the NYTime link.

It says cost sharing reductions are gone under the new plan. If that's the case, that seems like a huge reduction in benefits for low-medium income families. Currently a family can be on the hook for $13k maximum OOP per year but could much lower based on your income. I don't see a family making 40k able to afford that. Even now I think people feel that the ACA max OOP is too high.

[GTFan]

Yep, removing CSRs is a huge blow to lower-income folks under the ACA today. Going to be a lot of pain debating that one given that deductibles are one of the biggest issues for many even with CSRs.

[daylatedollarshort]

Quote:

Originally Posted by photoguy @DayLateDollarShort -- thanks for the NYTime link. It says cost sharing reductions are gone under the new plan. If that's the case, that seems like a huge reduction in benefits for low-medium income families. Currently a family can be on the hook for $13k maximum OOP per year but could much lower based on your income. I don't see a family making 40k able to afford that. Even now I think people feel that the ACA max OOP is too high.

With out of network, which can sometimes be hard to avoid even at in network hospitals, our annual family out of pocket max with our current Bronze plan is over $30K.

[GTFan]

Our BCBS HMO plan has unlimited OOP liability for out of network. I think the only other option we had this year, Kaiser, was the same.

[ERD50]

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Originally Posted by photoguy .... Currently a family can be on the hook for $13k maximum OOP per year but could much lower based on your income. I don't see a family making 40k able to afford that. Even now I think people feel that the ACA max OOP is too high.

Yes, I had been hoping for high deductible plans, as that normally makes sense for someone who can afford the smaller hits. But $13K OOP, plus the premiums, is quite a hit even for someone of means, especially if it was for an ongoing, maybe lifelong condition.

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Originally Posted by GTFan ... Assuming there's even a market left when the 30% surcharge for new insurance means that anyone healthy will simply not carry insurance until they need it. This is a recipe for a death spiral.

I dunno. Maybe that will be a death spiral, but is it really better/worse than the current plan? I don't think we know enough to say that. As I understand it, many healthy people aren't buying insurance now, and the penalties are low enough that they aren't having that much motivational effect.

Can we really say the 30% 'penalty' will provide less offset than the current 'penalties'? Where's your math for that?

-ERD50

[Ian S]

The only reason the insurance companies accepted the ACA's provision that prevented them from excluding folks based on pre-existing conditions was the individual mandate. Even then they wanted the penalty to be higher. Still, under ACA, they wouldn't have been required to take someone with a pre-existing condition outside of the narrow enrollment periods. In the new plan, the individual mandate is gone but exclusion based on pre-existing conditions is still banned and there appears to be no enrollment period limitation. I don't see how the insurance companies can accept that. I think they will cut their losses and run sooner rather than later. My sympathies to those who are trying to figure out if they can ER with such huge uncertainties in healthcare!

[woodguy00]

I'm not seeing anything in either bill that refers to purchasing policies across state lines. Am I missing it or is that something that would need to be handled in completely separate bills?

[scrabbler1]

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Originally Posted by Ian S The only reason the insurance companies accepted the ACA's provision that prevented them from excluding folks based on pre-existing conditions was the individual mandate. Even then they wanted the penalty to be higher. Still, under ACA, they wouldn't have been required to take someone with a pre-existing condition outside of the narrow enrollment periods. In the new plan, the individual mandate is gone but exclusion based on pre-existing conditions is still banned and there appears to be no enrollment period limitation. I don't see how the insurance companies can accept that. I think they will cut their losses and run sooner rather than later. My sympathies to those who are trying to figure out if they can ER with such huge uncertainties in healthcare!

+100

[Ian S]

Quote:

Originally Posted by ERD50 I dunno. Maybe that will be a death spiral, but is it really better/worse than the current plan? I don't think we know enough to say that. As I understand it, many healthy people aren't buying insurance now, and the penalties are low enough that they aren't having that much motivational effect.-ERD50

Well, the penalties have been rising and are becoming quite significant. Furthermore, even if you pay the penalty, you are still not covered in any way so the insurance companies are not on the hook if you get sick. With the new plan, folks (younger and/or healthier) have a much greater incentive to opt out as they can get insurance coverage whenever they need to. The insurance companies will then be on the hook for their medical expenses. The 30% premium surcharge will be a great bargain for those folks.

[Bir48die]

Lots of conjecture here. Like the news.

[samclem]

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Originally Posted by woodguy00 I'm not seeing anything in either bill that refers to purchasing policies across state lines. Am I missing it or is that something that would need to be handled in completely separate bills?

I think, because the bills are being passed using the reconciliation process, that this is an issue that couldn't be included.

[GTFan]

Is it true that they've gotten rid of specific enrollment periods in the proposal? Didn't see that in the NYT summary.

[MRG]

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Originally Posted by samclem I think, because the bills are being passed using the reconciliation process, that this is an issue that couldn't be included.

Thanks that makes sense.
Coming from an area where insurance companies already cross state lines I don't think its a big deal. Obviously I hope I'm wrong.

[MichaelB]

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Originally Posted by GTFan Is it true that they've gotten rid of specific enrollment periods in the proposal? Didn't see that in the NYT summary.

The House W&M bill does not mention enrollment.

[jimbee]

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Originally Posted by woodguy00 I'm not seeing anything in either bill that refers to purchasing policies across state lines. Am I missing it or is that something that would need to be handled in completely separate bills?

The ACA has a provision for allowing insurance companies to sell insurance across state lines, in effect January 2016.

http://www.ncsl.org/research/health/...purchases.aspx

[AllDone]

Quote:

Originally Posted by woodguy00 I'm not seeing anything in either bill that refers to purchasing policies across state lines. Am I missing it or is that something that would need to be handled in completely separate bills?

I haven't seen that yet, but I'm relying on the reports of healthcare economists who have read the plan which I have not. Buying across state lines is already included in the ACA, but so far the relevant parties haven't chosen to implement it anywhere. Here's a Forbes article from a few days ago about the weakness of the idea.

Since the idea is that buying across state lines would allow for savings due to economies of scale, there is also a little thought experiment that you can do. Since California has a pop of 38M and Canada has a pop of 34M, costs in California should be about the same as Canada!

[pb4uski]

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Originally Posted by daylatedollarshort It is 5 to 1 or set by the state per the New York Times summary of proposed changes here: https://www.nytimes.com/interactive/...ment.html?_r=0 So our premiums would go from around $1,700 a month to $2,830 or $33,960 a year, less $8K in subsidies for the two of us, plus deductibles and co-pays. ...

I don't think you can necessarily jump to the conclusion that your new premium would be $1,700/3*5. The 5:1 is a maximum, not a requirement... and its a lot more complicated than that.

I wonder if they will retain the 80% MLR aspect of ACA.

As one other poster mentioned, I don't see where these new bills affect the cost of health services at all and the escalating cost of health services is IMO the primary cause of the significant premium increases that we have been seeing lately.

[LastOfTheBoomers]

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Originally Posted by Carpediem Is the above saying I would be able to get some subsidy for COBRA coverage?

That is the way I read it - which could be a good thing - if income meets the limits then you could have 18 months of subsidized HI - that might make age 63.5 the new normal retirement age