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

[Ian S]

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]

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]

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]

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]

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/out-of-state-health-insurance-purchases.aspx

 

[AllDone]

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]

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...cs/republican-obamacare-replacement.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]

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

 

[walkinwood]

On CBS News this morning, the budget director said, regarding the HSA, that the plan would " dramatically increase where they can use them" ("they" being the contributors to the HSA).

Does anyone know what additional things the HSA can be used to pay for?

 

[pb4uski]

Lots of conjecture here. Like the news.

Yes, and in both cases probably real and fake as well.

 

[LARS]

I was quick to answer someone on this thread that basically, if passed as proposed, my read was that subsidies of ACA (nonMedicaid) are in place until 2020. So effectively no substantive change for 2017, 2018 and 2019.

I must say that today in the Press I've seen nothing confirming outright this view (just dates on various bits and bobs of ACA).

Do others concur with this conclusion of plan as proposed?

 

[Fedup]

I think the difference here is that currently you can't just go out at any time and get health insurance - only during open enrollment and other certain narrow situations. With this new plan, it looks like you can go at any time and get insurance but you just have to pay 30% more in premiums for a year. I think that will lead far more younger and/or healthier folks to drop out and only opt back in if they become seriously ill. The result will be higher premiums for the older folks who tend to have more health problems which due to the 5:1 ratio will lead to premiums for younger folks rising too. Leading more younger folks to drop out. Vicious circle situation probably leading to the so-called death spiral in the individual market.

I think from what I've read the window of purchasing is narrower. More like 30 days vs 90 days.

 

[ERD50]

Regarding ins companies accepting preconditions and the 30% penalty:

.... I don't see how the insurance companies can accept that. ...

Well, it seems that part of the process is discussions with insurance company reps (lobbyists), and I'm guessing this bill wouldn't exist in this form if the ins reps thought it was unworkable.

Based on that, I'm assuming the ins companies feel that the combination of changes, and this 30% increase is sufficient for them? Maybe not in isolation, but the entire package?

-ERD50

 

[Fedup]

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.

With the new plan, my 26 year old will be able to save money. Right now she pays $252 for Kaiser plan and gets no subsidy, even though she technically should, but somehow coveredca didn't give it to her. So she went with the private plan. She will be paying $70-80 with the new plan. There is smaller window to enroll, it was in the news before this. So I think the young people will come out better. There is a surge of enrollment in health Nauruan even recently when people heard of continuous coverage as part of the new health plan to be released.

 

[GTFan]

Well, it seems that part of the process is discussions with insurance company reps (lobbyists), and I'm guessing this bill wouldn't exist in this form if the ins reps thought it was unworkable.

Based on that, I'm assuming the ins companies feel that the combination of changes, and this 30% increase is sufficient for them? Maybe not in isolation, but the entire package?

There were lots of discussions with insurance co's for the ACA when it was enacted too, and now look at the almost non-existent marketplace in many areas. With basically no changes to the original bill other than the reversal of the expanded Medicaid requirement.

I think it's premature to say that anything is sufficient given that we don't know all the particulars around enrollment. And more importantly, what the long-term impact is going to be if people realize they can game the system.

 

[Fedup]

Regarding ins companies accepting preconditions and the 30% penalty:

Well, it seems that part of the process is discussions with insurance company reps (lobbyists), and I'm guessing this bill wouldn't exist in this form if the ins reps thought it was unworkable.

Based on that, I'm assuming the ins companies feel that the combination of changes, and this 30% increase is sufficient for them? Maybe not in isolation, but the entire package?

-ERD50

On the CNBC breaking news, representatives said people took advantage of the old law, coming and going to take advantage of the 2 months window. So this is designed to stop that.

 

[jim584672]

I think from what I've read the window of purchasing is narrower. More like 30 days vs 90 days.

I read Price proposed the window be narrowed from 90 to 45 days. Also crack down on special enrollment periods, more verification.

 

[Fedup]

On CBS News this morning, the budget director said, regarding the HSA, that the plan would " dramatically increase where they can use them" ("they" being the contributors to the HSA).

Does anyone know what additional things the HSA can be used to pay for?

I've read over the counter stuff, even like band aids, I hope.

 

[exnavynuke]

I've read over the counter stuff, even like band aids, I hope.

It gets rid of section 106 (f) that limited HSA approved spending to prescriptions and insulin, but I haven't seen anything saying what the new "allowed" stuff will be (I'm assuming it won't be just anything you feel like spending money on).

 

[Pilot2013]

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!

I mentioned this on another thread, but it amazes me that in just a short time span, all of a sudden this HCI issue wrt ER is such a topic. Just goes to show how something like this (ACA overhaul) can be a sacred cow so fast, and changing it can be so difficult. It really wasn't that long ago that the ACA, and the subsidies base on income (that are "Played" so well by so many now) weren't even a consideration or factor. Can it really be that hard to turn back for improvement? Per my statement on the other thread:

Did people really NOT ER before the ACA?

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.

 

[karen1972]

On CBS News this morning, the budget director said, regarding the HSA, that the plan would " dramatically increase where they can use them" ("they" being the contributors to the HSA).

Does anyone know what additional things the HSA can be used to pay for?

Paul Ryan has stated in the past, they wanted to open up HSAs to also include premiums and payment for other peoples health care, such as your parents. I haven't seen the details in these bills state that, but that is some of those are likely to make its way into the bill.

 

[Sue J]

I think this is an important point:

"SECTION_02: ADDITIONAL MODIFICATIONS TO PREMIUM TAX CREDIT
Under current law, qualified health plans must meet certain requirements for households to be eligible for the premium tax credit. This section amends those requirements to make available premium tax credits for the purchase of “catastrophic-only” qualified health plans and certain qualified plans not offered through an Exchange. "

If I'm reading it correctly it should bring back catastrophic only health insurance, something that is personally very attractive.

And this reads that a married couple, over age 60, with less than $150K income will get $8,000 per year tax credit:

"This section creates an advanceable, refundable tax credit for the purchase of state-approved, major medical health insurance and unsubsidized COBRA coverage. To be eligible, generally, an individual must not have access to government health insurance programs or an offer from any employer; and be a citizen, national or qualified alien of the United States, and not incarcerated. The credits are adjusted by age:
• Under age 30: $2,000
• Between 30 and 39: $2,500
• Between 40 and 49: $3,000
• Between 50 and 59: $3,500
• Over age 60: $4,000
The credits are additive for a family and capped at $14,000. The credits grow over time by CPI+1. The credits are available in full to those making $75,000 per year ($150,000 joint filers)."

Finally with the higher contribution limits to an HSA, it seems a married couple can withdraw up to $13,100 from a tax deferred account, such as an IRA or 401k, deposit in an HSA and protect the withdrawal from taxation.

Disappointingly I don't read anything that fundamentally will reduce the cost of health care.

Regarding HSAs, I'm glad to see them considering HSA contributions which correlate with actual high deductible plans. I would also like to see HSAs available to users of any kind of policy, not just the defined HDHPs.

Currently even silver plans have huge deductibles and max out of pocket costs but are excluded from being HSA eligible due to having office visit co-pays or Rxs paid before the deductible is met.

I read the Ways and Means summary so if I missed that, let me know.

As a user of ACA I'm following this closely, but if these changes won't apply until Jan 2020 it will only matter to me for 1 month as I turn 65 in Feb 2020.

 

[Refresher]

Did I read it correctly that the current ACA subsidies will stay in effect until 2020?

I heard the current subsidies will be phased out over 3 years? What does that mean. Will a current subsidy of $500 remain for the next 3 years or maybe slowly be reduced ($400 for the rest of 2017, $300 in 2018 etc).
Or does it appear as soon as the law goes into effect the new tax credit plan starts ($4000 a year for many of us).