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

[travelover]

Quote:

Originally Posted by socca ........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.

Yea, too bad no other developed countries have faced this problem and found a workable solution.

[Pilot2013]

Quote:

Originally Posted by socca 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.

I am in agreement, mostly with the part about how I am not sure myself how to solve the COST issue, but I am convinced redistribution is not the way. Primarily because once it is in place (as we are seeing now) it is very hard to eliminate without someone being demonized, once we DO figure out the cost issue.

[exnavynuke]

Quote:

Originally Posted by travelover Yea, too bad no other developed countries have faced this problem and found a workable solution.

Why travelover... that sounds suspiciously like sarcasm....

[Bryan Barnfellow]

"SECTION_15: REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE
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. "

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.

[bamsphd]

Quote:

Originally Posted by Pilot2013 Did people really NOT ER before the ACA?

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.

[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."

Quote:

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-politi...pioid-epidemic

[daylatedollarshort]

Quote:

Originally Posted by bamsphd 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]

Quote:

Originally Posted by Refresher 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.

Quote:

Originally Posted by Refresher 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]

Quote:

Originally Posted by Fermion 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:

Quote:

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

from: https://www.buzzfeed.com/paulmcleod/...mpy#.ildkrMxv9

[Refresher]

Quote:

Originally Posted by MBSC 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]

Quote:

Originally Posted by brewer12345 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]

Quote:

Originally Posted by brewer12345 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.

Quote:

Originally Posted by 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.

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]

Quote:

Originally Posted by LARS 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]

Quote:

Originally Posted by socca 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]

Quote:

Originally Posted by 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?

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]

Quote:

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

Why do you say that?