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

[explanade]

Here's an early summary.

http://www.vox.com/2017/3/6/14829526/american-health-care-act-gop-replacement

One thing I haven't heard too much about were the high-risk pools ideas they were tossing around. They would spend $5-10 billion a year when some analysts said it would probably require at least ten times that much.

But if people with pre-existing conditions can get coverage any time, just by paying a 30% surcharge or penalty, then people can just wait until they're sick?

However now there's talk of the high-risk pools being for "exceptionally costly" people or the insurers being reimbursed for patients who get over $50k in benefits a year:

The leaked draft does have a safety net for people who can’t afford to buy this more expensive coverage. It would invest $100 billion over 10 years into a Patient and State Stability Fund. States could use this money to bump up the size of the tax credits in the individual market (more on that in a minute), build high-risk pools for those with exceptionally costly medical conditions, or send money to insurers who get stuck with especially costly patients (people who have claims above $50,000 in a single year).

 

[GTFan]

Let's all take a deep breath. There's a lot of work that will have to be done in both sides of congress before the "next" final solution for the HCI crisis is determined.

I don't see anyone hyperventilating here, it's a hot topic because we finally have a proposal out there to be discussed. We're just trying to figure out the new terms and impact.

And yes, people did ER before the ACA but HC and the market for it is a LOT more expensive than it was then. And more importantly as pb4uski said, there is no attempt to rein in HC costs in the new proposal which is by far the biggest issue here.

 

[LARS]

And yes, people did ER before the ACA but HC and the market for it is a LOT more expensive than it was then. And more importantly as pb4uski said, there is no attempt to rein in HC costs in the new proposal which is by far the biggest issue here.

Indeed. I was "happily" buying high deductible HI prior to ACA.

So if we went back to the "old" days of catastrophic insurance, with less mandated basic coverage, so be it. Problem is that insurance product was outlawed under ACA.

 

[GTFan]

Here's an early summary.

http://www.vox.com/2017/3/6/14829526/american-health-care-act-gop-replacement

Thanks. I find it odd that none of the summaries I've read mention the elimination of the CSR subsidies, which will have a huge impact on costs for lower income folks. All they say is that current income-based PTCs are replaced by age credits.

Once the real numbers get out there for folks making less than 250% FPL, might be a lot of phone calls to Congress.

 

[molly312]

I totally agree with GTFan & pb4uski -"there is no attempt to rein in HC costs in the new proposal which is by far the biggest issue here". All that is happening is that cost is being shifted away from the government and leaving more people without health insurance. NOBODY has proposed changes to lower the COST. Endless paperwork and extra tests to avoid faulty malpractice claim.....ridiculous drug costs. I had chemo and was given a drug after each dose....Claimed cost was 5K-7K per dose. In Canada -the cost is $60. Do you see a problem that has been addressed in the new plan?? This is just moving the chess pieces around on the board.

 

[MichaelB]

Thanks. I find it odd that none of the summaries I've read mention the elimination of the CSR subsidies, which will have a huge impact on costs for lower income folks. All they say is that current income-based PTCs are replaced by age credits.

Once the real numbers get out there for folks making less than 250% FPL, might be a lot of phone calls to Congress.

There are 2 bills. The repeal of cost sharing is in the House Energy and Commerce bill, Subtitle D Section 131.

 

[explanade]

I think it would take a long time to address costs directly. Probably requires structural changes which hospitals, doctors and other providers would resist.

There has also been some talk about negotiating drug prices but that would require rolling back parts of the Medicare Part D law.

But health care is suppose to be just the first item on the legislative agenda. They need to be done with it first to set up the tax cuts. So anything that is going to take over a year to negotiate, like addressing costs, probably wasn't likely.

 

[molly312]

Again - hurry up and pass it through without any structural changes. Same-o. Isn't that how we got here in the first place?

 

[LARS]

The only thing I really want to see is bipartisan support of whatever ultimately gets passed. We cannot keep passing important legislation critical to the country that every so many years gets repealed when the power structure swings back to the other side.

 

[Pilot2013]

Indeed. I was "happily" buying high deductible HI prior to ACA.

So if we went back to the "old" days of catastrophic insurance, with less mandated basic coverage, so be it. Problem is that insurance product was outlawed under ACA.

That was my point. Where there's a will, there's a way. That, and how quickly something becomes a "given" once implemented.

I've told many an employee to "be careful what you take on from others, as they will gladly allow you to take it, and really be surprised when attempts are made to give that responsibility back to it's rightful owner".

 

[pb4uski]

The only thing I really want to see is bipartisan support of whatever ultimately gets passed. We cannot keep passing important legislation critical to the country that every so many years gets repealed when the power structure swings back to the other side.

I totally agree, but IMO the unfortunate reality is that bipartisan support is never going to happen in this political environment because the sides are too polarized.

 

[NW-Bound]

I totally agree with GTFan & pb4uski -"there is no attempt to rein in HC costs in the new proposal which is by far the biggest issue here". All that is happening is that cost is being shifted away from the government and leaving more people without health insurance. NOBODY has proposed changes to lower the COST...

Count me in among those who are disappointed to see no cost control measures. If it were not for the huge cost increase, ACA would have been fine too.

The 30% penalty of premium increase for 12 months for people who do not buy insurance is a joke. Can I buy car insurance the same way? I will gladly pay a lot more than 30% penalty, if I am allowed to buy insurance after my car has been totaled.

 

[scrabbler1]

Before the ACA's exchanges went into effect in 2014, I was paying nearly $700 a month in 2009-2011 and had few choices here in New York, a high-cost area for individual HI. After the exchanges came in, I was paying about $425 a month, around the same as I was paying in 2009 (before the 50% increase in 2 years).


My MAGI is near the upper limit to receive a subsidy, so having the subsidy itself doesn't mean much. But having the individual mandate brought more (healthy) people into the system and averted the growing death spiral I experienced in 2010 and 2011. Should the mandate end, I expect my rates to rise sharply again, far more than any higher subsidy I would receive under the proposal.


What's the use of getting $300 more per month in a tax credit when my premiums will rise $400 per month?

 

[MichaelB]

This is a very good thread. . Between the two bills there are still many provisions not yet discussed. Let's make an effort to keep the discussion on the changes and how they impact members here, and stay away from the politics.

 

[SecondCor521]

Under the proposed bills, there will be winners and losers going from the ACA to whatever we get next, because the credits were based on income and now will be based on age.

The penalty will also be better for some and worse for others since it was based on income and now is based on cost of insurance.

For me personally, I am currently on an ACA silver with CSR and manage my income to below 200% FPL, I get ~$500 in monthly ACA premium assistance, and we have plenty of providers and plans available to choose from. Under the new proposal, I would probably switch to a catastrophic plan (we're reasonably healthy in our family knock wood), take the remainder of the $7000 annually in refundable tax credits and plonk that money into an HSA to pay for OOP stuff. I would also consider increasing my Roth conversion amounts.

 

[Ronstar]

I have HI under my DW's retiree plan. Under ACA, I probably would have been subject to tax on a "Cadillac plan" in 2020. The wrinkle is that DW would be on Medicare starting in July, 2019, and I would start Medicare in August, 2020. So the tax would have been on a partial year for only me in a family plan. That would have been interesting. Under the new plan, it looks like the taxation date will be pushed back 5 years, at which time we'll both be on Medicare.

 

[zedd]

...

Off the cuff, I think I will come out way ahead. There are many here who are minimizing their income for ACA credits and they can junk that and move on to low-cost Roth conversions.

Maybe for some. My 2017 subsidy is $8196. If I'm reading this right, my subsidy (i.e. credit) would be reduced to $3500.

My gripe is that the focus is in the wrong place. Once again they attempting to make HEALTH INSURANCE "affordable".

The real problem is the COST of HEALTH CARE.

 

[audreyh1]

Sounds like there is quite a bit left out of this summary - [-]like losing coverage for pre-existing conditions if your medical insurance coverage lapses for >63 days.
[/-]
DH said he read that in a Money article review. He'll get me the link.

OK - sorry about that. DH was reading a 3/7 article, but it linked to a 1/24 article that had the above information which is no longer current, as far as I can tell. Obamacare Repeal: The GOP's Plan for Pre-Existing Conditions | Money

 

[Lisa99]

How would this compare to the ACA subsidies?

It's significantly less for us because it changes the income test from what I understand. Our subsidy would drop by almost $6k/year. We're in wait and see mode.

 

[athena53]

Sounds like there is quite a bit left out of this summary - like losing coverage for pre-existing conditions if your medical insurance coverage lapses for >63 days.

Yes, that should be emphasized. It kills the strategy of "I'll buy insurance as soon as I need an operation" and thus keeps more healthy people in the insured population.

 

[exnavynuke]

Sounds like there is quite a bit left out of this summary - like losing coverage for ore-existing conditions if your medical insurance coverage lapses for >63 days.

DH said he read that in a Money article review. He'll get me the link.

I didn't see anything about this. Pre-existing conditions still seem to be covered from what I've read. I'd be interested to see the link to that information if true. 63 days IS the time period you have to be uninsured before you can be assessed the 30% premium increase however, so it's possible he was just mistaken about what it was saying?

 

[MichaelB]

Sounds like there is quite a bit left out of this summary - like losing coverage for ore-existing conditions if your medical insurance coverage lapses for >63 days.

DH said he read that in a Money article review. He'll get me the link.

It's section 133 of the Energy and Commerce Bill http://energycommerce.house.gov/sit...ocuments/Section-by-Section Summary_Final.pdf

 

[samclem]

It seems a lot of people are fixated on the amount of the subsidies they'll get in comparison to what they got before. Isn't the far more important metric the final cost of the coverage (and its utility)? Ever-higher subsidies for ever-more expensive insurance to cover ever-more expensive health care doesn't sound sustainable.

 

[burch64]

I would think you would have to spend at least $8,000 on premiums to get the $8,000 credit.

Someone posted that they would buy a high deductible plan and put the difference (of the $8,000) in a HSA.

 

[ikubak]

It'll definitely be simpler in that there will be no need to reconcile what you got based on your estimated income to what you should have got based on your actual income.

Off the cuff, I think I will come out way ahead. There are many here who are minimizing their income for ACA credits and they can junk that and move on to low-cost Roth conversions.

This will be a good thing for many ERs. It's a challenge to maximize your benefit when the rules of the game keep changing, but I'm in favor of simplifying the product. I had worked out a plan to keep MAGI low and get insurance for less than 1200/year for a couple. If this new plan goes through, I can get a 7500 tax credit and then shop for whatever plan makes the most sense. I won't have to work at keeping my MAGI low. I'll be able to convert to Roth in the lowest tax brackets and reduce my exposure to RDMs later in life. This could be good.