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

[bamsphd]

With off-exchange HSA qualified policies, depending on how premiums change for old folk with 3:1 removed, I might win of lose the spreadsheet cost game.

However, I'm really going to miss "actuarial value" and potentially miss "essential health benefits."

The bill does technically keep mandatory “essential health benefits” for private insurers, meaning individual market plans and small group plans will still have to cover, among other mandatory benefits, “mental health services and addiction treatment.”


But the bill creates a big loophole: In 2020, it will eliminate what’s known as “actuarial value,” which essentially requires that insurers pay for a certain amount of a person’s care.

from: http://www.vox.com/policy-and-politics/2017/3/7/14841876/ahca-obamacare-repeal-opioid-epidemic

 

[daylatedollarshort]

I tried and failed to get insurance at any price before the ACA. So I personally postponed ER until the Supreme Court upheld the ACA. Then I took Cobra followed by no-subsidy HSA qualified policies.

Lots of people ER'ed with retiree insurance (ex-Military, ex-Gov, ex-Union, ...). The minority without any pre-existing conditions sometimes risked (often in ignorance) having their insurance cancelled.

However, not many people voluntarily ERed if they knew they couldn't buy health insurance. Without insurance you don't get negotiated prices, without negotiated prices self insurance is problematic.

We went on COBRA and then had plans to go on post COBRA conversion or a small group plan (our own business of two could qualify for group rates in California and no pre-existing exclusion clauses). I think our first COBRA policy was under $1K a month for a family of 4. I had $20K a year in the budget for healthcare until Medicare in our retirement plan, which seemed like more than enough at the time.

Premiums more than doubled the next year and out of pocket max increased, then the ACA and subsidies came along after that and our premiums went way down. It has been a wild ride for us cost-wise up and down and now probably back up again next year.

 

[MBSC]

How?
If your income is 15k a year and your premiums are 1k a month under the new plan with the 4k tax credit your paying 8k a year which is 53% of income. How does the 11.5% figure in?

The poster asked about the transition period before the new tax credits start in 2020. The caps on individual responsibility go away in 2020.

Or does it mean if your income is 15k the insurance companies must offer a plan for $5725 which would make your responsibility $1725 or 11.5%?

Prior to 2020, you may qualify for Premium Tax Credits (PTC) if your income is below 400% FPL. Your responsibility is the percentage found in Table 2 of the instructions for IRS Form 8962. It is a sliding scale so a person earning $15k does not pay 11.5% of MAGI toward SLCSP premiums during 2017 or during the 2018-2019 transition period. But, that table is changing slightly for the 2018-2019 transition period as described on page 78 of the bill. One of the changes is that individuals over age 59 in the 300%-400% FPL range will pay 11.5% MAGI towards premiums in 2018 compared to 9.69% in 2017.

 

[bamsphd]

It definitely will be interesting. We had insurance companies pulling out of markets where people were getting $15,000 or more of subsides if you include cost sharing. Exactly how fast are they going to run for the door when the subsidy drops to $6000?

However, I predict insurance executives will generally support the proposal (perhaps while abandoning the individual market) because:

Insurance industry execs are getting a new tax break on salaries above $500,000 [mod edit]

from: https://www.buzzfeed.com/paulmcleod...eak-for-insura?utm_term=.oaJXdqmpy#.ildkrMxv9

 

[Refresher]

The poster asked about the transition period before the new tax credits start in 2020. The caps on individual responsibility go away in 2020.

Prior to 2020, you may qualify for Premium Tax Credits (PTC) if your income is below 400% FPL. Your responsibility is the percentage found in Table 2 of the instructions for IRS Form 8962. It is a sliding scale so a person earning $15k does not pay 11.5% of MAGI toward SLCSP premiums during 2017 or during the 2018-2019 transition period. But, that table is changing slightly for the 2018-2019 transition period as described on page 78 of the bill. One of the changes is that individuals over age 59 in the 300%-400% FPL range will pay 11.5% MAGI towards premiums in 2018 compared to 9.69% in 2017.

I'm not understanding all the news about low income people losing insurance when the subsidy changes are minimal for 2 or 3 more years.

 

[brewer12345]

Wow, 130 posts so far on something that is almost certainly going nowhere. Wake me when you hit 250...

 

[imoldernu]

Maybe not relevant here, but wondering if there may be any change to the "unlimited coverage" law that sets no limits on time or expense for long term health coverage insurance.
One son spent 6 months in ICU 15 years ago, before recovering. You can only imagine the cost, then paid for by medicaid.

 

[exnavynuke]

Wow, 130 posts so far on something that is almost certainly going nowhere. Wake me when you hit 250...

This seems even more relevant now that I'm reading reports that some Republicans in both the House and Senate dislike the leadership's bill enough that they plan on introducing alternative legislation tomorrow.

House, Senate conservative Republicans plan own Obamacare repeal bill | Reuters

 

[MichaelB]

Wow, 130 posts so far on something that is almost certainly going nowhere. Wake me when you hit 250...

If it makes it there someone will be sure to let you know.

Maybe not relevant here, but wondering if there may be any change to the "unlimited coverage" law that sets no limits on time or expense for long term health coverage insurance.
One son spent 6 months in ICU 15 years ago, before recovering. You can only imagine the cost, then paid for by medicaid.

Sorry to hear of those troubles. So far, no change to "no limits".

 

[ARB57]

I probably missed it...but...is removal of the 3 times limit for "older" folks (to 5 times) delayed until 2020, like most other elements of the GOP proposal?

 

[Sunset]

Got to love the ER crowd: already scheming to maximize!

My plan is to get the tax credits, not buy insurance until I get cancer and then buy it paying the 30% penalty for one year. No need for just young folks to maximize their HI returns.

It might actually be a good idea.

 

[audreyh1]

Back in the old days (before Obamacare), health insurance companies provided their policyholders with indemnification only against future adverse medical events. They worked aggressively to avoid covering existing medical conditions. I went through this medical underwriting process many times - unpleasant, to be sure, but I considered it a necessary evil in order to keep insurance premiums reasonable.

My personal preference would be to return to the old days, where health insurance companies sold only indemnification against future adverse medical events, and allow some other mechanism to help pay the medical cost of existing conditions. Insurance companies shouldn’t be allowed to deny all coverage to someone with existing conditions, but they should be allowed to exclude existing conditions from coverage and let some other mechanism help pay for them.

So, what might this other mechanism to help pay for existing conditions look like? Who would pay the taxes to provide this benefit? How would this program be administered? Would we need to create a new health care bureaucracy, or can an existing bureaucracy be adapted? I have no idea - I’m not an expert in health policy matters, just a guy trying to avoid being financially ruined by the American healthcare system.

Lots of companies just denied coverage if you had what they considered "pre-existing" conditions. Also it became relatively common practice for an insurance company to come after a customer after they developed something and claim the customer was untruthful on their application, finding any little thing, and dropping coverage.

The mechanism you may be looking for is a state health risk pool, which provided me good insurance at about 2x the price because I had a pre-existing condition of a little extra cartilage in one small toe. A condition requiring no treatment, but it still scared off the insurance company and I was denied coverage after my COBRA ran out. The state risk pool was dissolved when the ACA came online.

Since COBRA ended (16 years or so) I have several more pre-existing conditions appear. None of them lifestyle related, by the way. There are tons of health conditions that have nothing to do with lifestyle choices.

A big part of what is ruinous about the US health care system is not the insurance, but the cost of health care itself. Way more than other countries - way out of control.

 

[Refresher]

I probably missed it...but...is removal of the 3 times limit for "older" folks (to 5 times) delayed until 2020, like most other elements of the GOP proposal?

Good question, I'd like that answer too

Seems like not much is really changing for 3 years which in politics can be like 100 years of nothing accomplished.

 

[explanade]

Doesn't matter, it doesn't appear like this bill will survive in its current form.

 

[audreyh1]

Doesn't matter, it doesn't appear like this bill will survive in its current form.

Why do you say that?

 

[explanade]

Looks like they're getting pushback from many members of their own party, with some planning to introduce alternative bills.

 

[MBSC]

I probably missed it...but...is removal of the 3 times limit for "older" folks (to 5 times) delayed until 2020, like most other elements of the GOP proposal?

1/1/2018 per Section 135.

SEC. 135. CHANGE IN PERMISSIBLE AGE VARIATION IN HEALTH INSURANCE PREMIUM RATES.

‘‘or, for plan years beginning on or after January 1, 2018, as the Secretary may implement through interim final regulation, 5 to 1 for adults (consistent with section 2707(c)) or such other ratio for adults (consistent with section 2707(c)) as the State involved may provide’’.

 

[Fedup]

Back in the old days (before Obamacare), health insurance companies provided their policyholders with indemnification only against future adverse medical events. They worked aggressively to avoid covering existing medical conditions. I went through this medical underwriting process many times - unpleasant, to be sure, but I considered it a necessary evil in order to keep insurance premiums reasonable.

My personal preference would be to return to the old days, where health insurance companies sold only indemnification against future adverse medical events, and allow some other mechanism to help pay the medical cost of existing conditions. Insurance companies shouldn’t be allowed to deny all coverage to someone with existing conditions, but they should be allowed to exclude existing conditions from coverage and let some other mechanism help pay for them.

So, what might this other mechanism to help pay for existing conditions look like? Who would pay the taxes to provide this benefit? How would this program be administered? Would we need to create a new health care bureaucracy, or can an existing bureaucracy be adapted? I have no idea - I’m not an expert in health policy matters, just a guy trying to avoid being financially ruined by the American healthcare system.

My husband and I were unemployed in 2003, COBRA would have cost about $1000, we paid $250 for a family. I don't how insurance premium went up so fast so soon since.

 

[socca]

Lots of companies just denied coverage if you had what they considered "pre-existing" conditions. Also it became relatively common practice for an insurance company to come after a customer after they developed something and claim the customer was untruthful on their application, finding any little thing, and dropping coverage.

As I recall, some of the worst insurance company practices were banned prior to the ACA, with only modest impact on premiums. I'm definitely not interested in returning to the days when insurance companies had free rein to abuse their clients.

 

[ERD50]

Doesn't matter, it doesn't appear like this bill will survive in its current form.

Why do you say that?

Looks like they're getting pushback from many members of their own party, with some planning to introduce alternative bills.

Agreed with the last post above. I hope I'm not getting too far into politics here, this is just observation and explanation, not judgement - but I think the Dems faced the same thing with the ACA. The ACA made some important progress, but there were so many special interest issues that it took a bunch of special carve outs to get enough votes behind it. I forget the names now, but the carve outs were named for the States that got some special treatment where they needed the votes.

The R's are facing the same thing. Disagreement on just what form the changes should take. So there will be in-fighting.

It's a shame really. As I said, the ACA made important progress, but like anything, it was flawed and lacking in some key areas. The best thing for all of us is to improve on the flawed parts and fill the gaps, but I suspect there will be so much infighting, they may never 'get it together' to get positive changes through. Sad.

-ERD50

 

[GTFan]

They have to do something, won't be able to face the voters next year without it. The dog has caught the car.

I've never really understood why it's ok to have government-provided insurance in the form of Medicare and Medicaid but it's totally not ok to provide a framework like the ACA (flawed as it is) for the rest of us. And that's basically what repeal (and not replace because there's no consensus) is all about, getting the government out of HC even though it's been there for 50 years for a large part of society.

 

[explanade]

Some people are not okay with Medicare or the VA.

 

[ERD50]

FWIW - The Secretary of Health and Human Services took questions at today's press briefing. See the first 30 minutes. This is on cspan as well, but the youtube interface is far more user-friendly. See what you think, but if I were to sum it up, I'd say "It's a Work in Progress". He made references to Phase 2 & 3:

-ERD50

 

[NW-Bound]

As usual, the 6-8 million of us (unrepresented) Americans living outside the US are out of sight and out of mind. We have to pay for Medicare while abroad but can't use it, and in some cases -- such as my own in Switzerland -- we have to pay fully out of pocket for our local health insurance. Mine and my wife's comes to close to the equivalent of $20,000 annually. I retain only a slim hope that we might be included in the tax credit section in the final version of the bill.

$20K for health insurance. It is still lower than in the US, but not vastly cheaper.

Though healthcare in the US is the most expensive, it looks like it is expensive everywhere in the developed world, hence the high insurance premium. Either we pay it directly out of pocket or via higher taxes, it is never free.

People used to reminisce about the old days when healthcare was so inexpensive, but it was not the same, was it? We now have more drugs, more expensive treatments, more surgeries that are done routinely. For example, I wonder when hip and knee replacements started to become routine. I guess that it used to be that if an aspirin did not help you, it's tough luck. If you get anything worse, you die. There was no CAT Scan, no MRI, PET Scan, etc.. No angioplasty, no stents. Hence, healthcare was cheap, because it was so simple.

 

[NW-Bound]

It just occurred to me that retirement was also simpler. People didn't expect to live long after stopping work, so that cut down expenses. Ditto for medical costs that simply did not exist back then, nothing much to do copays on. And then, if one lingered on, he might live in pain (no knee/hip replacements, remember?), or suffered from arthritis, etc... Could not do much, other than staying around the house listening to the radio.

Ah, the simple, inexpensive life. And short one too.