Obamacare

[obgyn65]

I made a point. You made a point. We disagree on this topic. I just don't want to waste my time arguing with you on this topic, ERD50, and run the risk of getting this thread shut down.

Just remember one thing : while you spend time posting in these forums from the comfort of your home, I am the one who takes care of these patients' cancer and other conditions at free clinics. Until you do that, please don't be so judgmental and self righteous about 'responsible' vs 'non responsible' patients.

Of course I agree that I don't want to see a responsible person drowned in health care expenses. But that is separate from whether this Act will reduce overall costs or not. You are throwing in a Red Herring, and that is commonly done when one cannot address the actual issue at hand.

-ERD50

 

[scrinch]

True, but then it should be called the "More Affordable For Some, Care Act". My point is, "more affordable" should refer to the overall costs, not some segment, and that is very questionable if it can achieve it's self-titled goal.

You make a valid point. Maybe not the most apt of names. The people being added to the roles of the "healthcare covered" will, on average, be poorer and less healthy than those currently on that list, so the average per-person cost is probably going to go up for those who pay their full share (plus part of the subsidy with their taxes). I hope that transparency and openness of the new health insurance market will help drive the price down some, but once the system is in place I hope there will be more opportunity to look for additional ways to drive costs down.

 

[jclarksnakes]

True, but then it should be called the "More Affordable For Some, Care Act". My point is, "more affordable" should refer to the overall costs, not some segment, and that is very questionable if it can achieve it's self-titled goal. Would the FCC allow that in an ad for a commercial product?

Of course I agree that I don't want to see a responsible person drowned in health care expenses. But that is separate from whether this Act will reduce overall costs or not. You are throwing in a Red Herring, and that is commonly done when one cannot address the actual issue at hand.

-ERD50

+1

I think the big winners will be the insurance companies. While most of America waits to see how the details turn out the insurance guys are working feverishly figuring out how to make the most money possible from the ACA. Somebody will have to pay the extra money they will make.

 

[jclarksnakes]

I made a point. You made a point. We disagree on this topic. I just don't want to waste my time arguing with you on this topic, ERD50, and run the risk of getting this thread shut down.

Just remember one thing : while you spend time posting in these forums from the comfort of your home, I am the one who takes care of these patients' cancer and other conditions at free clinics. Until you do that, please don't be so judgmental and self righteous about 'responsible' vs 'non responsible' patients.

People who truly do not want to waste their time arguing usually do not start the next sentence with "Just remember one thing".

 

[scrinch]

I think the big winners will be the insurance companies. While most of America waits to see how the details turn out the insurance guys are working feverishly figuring out how to make the most money possible from the ACA.

Certainly there will be more customers and more dollars flowing through the health insurance system. Let's hope the enhanced transparency being set up in the system will force the insurance companies to compete a little harder for the business, shaving margins in the process.

 

[M Paquette]

Covered California, the PPACA health exchange for California, has rolled out it's benefit plans and related information.


http://www.healthexchange.ca.gov/Documents/Covered CA standard benefit plans 2013 FINAL.pdf

The exchange's home page: http://www.coveredca.com/

They put together a crude cost estimator, which will give a quote for a "Silver Plan" policy. A typical high deductible policy such as many of us use is more like a "Bronze Plan" policy. Costs look comparable to current Preferred Provider plans from Aetna, Blue Cross, etc for California residents. That is, ouch... But we're used to it. (They probably just loaded in the current prices of plans similar to the Silver Plan benefits.)

http://www.coveredca.com/resources/calculating-the-cost/

 

[MichaelB]

Let's keep it friendly, folks.

Covered California, the PPACA health exchange for California, has rolled out it's benefit plans and related information.


http://www.healthexchange.ca.gov/Documents/Covered CA standard benefit plans 2013 FINAL.pdf

The exchange's home page: Affordable Health Insurance | Covered California

They put together a crude cost estimator, which will give a quote for a "Silver Plan" policy. A typical high deductible policy such as many of us use is more like a "Bronze Plan" policy. Costs look comparable to current Preferred Provider plans from Aetna, Blue Cross, etc for California residents. That is, ouch... But we're used to it. (They probably just loaded in the current prices of plans similar to the Silver Plan benefits.)

Health Insurance Calculator | Covered California

Thanks for that link. After a quick look at the prices it seems they are in the same ballpark as Mass. Not a surprise.

 

[comicbookgujy]

So I plugged in the # for the CA Covered Care and for a househould of 2, if I decide to quit my full time job, I need to ensure my part time job is less than $21k a year so I qualify for Medicare

 

[explanade]

Tried different numbers on that CA Covered Care, it only had max OOP number and a monthly premium that was 1/12 of the max OOP.

Anyways, for those already FIRE'd how many are going to use these plans? Can't you withdraw just enough to stay under the limits for the max subsidy?

Of course, that means a lesser lifestyle than one might otherwise be able to afford, but LBYM and all that.

 

[comicbookgujy]

If I can truely qualify for Obamacare aka getting free health insurance by making less than $21k a year, I am definitely going to quit this high stress job and work part time so I can get my personal life together!!! Thanks Obama!

 

[Richard8655]

People who truly do not want to waste their time arguing usually do not start the next sentence with "Just remember one thing".

I have to disagree. Obgyn is not wanting to argue, but rather is making an extremely important point. Before ACA, the majority of personal bankruptcies in the U.S. was and is due to the lack of affordable health care. Every other advanced country in the world makes sure that doesn't happen to its own citizens.

So his point stands very well, and should be understood in this context. In my opinion, we're now starting to join the rest of the advanced world with universal care for our people regardless of income and affordability.

 

[photoguy]

+1

I think the big winners will be the insurance companies. While most of America waits to see how the details turn out the insurance guys are working feverishly figuring out how to make the most money possible from the ACA. Somebody will have to pay the extra money they will make.

I thought the insurance companies lobbied heavily against the ACA. Maybe I'm wrong? I didn't follow this too closely.

The ACA does limit the medical loss ratio. Basically insurers can't get more than 15-20% profit. I thought some posters here already reported that insurers had to give back some of their premiums.

 

[Katsmeow]

They put together a crude cost estimator, which will give a quote for a "Silver Plan" policy. A typical high deductible policy such as many of us use is more like a "Bronze Plan" policy. Costs look comparable to current Preferred Provider plans from Aetna, Blue Cross, etc for California residents. That is, ouch... But we're used to it. (They probably just loaded in the current prices of plans similar to the Silver Plan benefits.)

Health Insurance Calculator | Covered California

For curiousity I did this. There wasn't a way to tell it that the household size wasn't equal to the number of people being insured. That is, for example, in my house DH is already on medicare. If I were to put in a 2 person household size with my age (I'm youngest) it says that the insurance cost is $1723 a month (ouch). If I put in a 1 person household size it goes down to $635 a month. So basically it costs more to insure a 2 person household size than to have 2 people insured not in the same household. Also the premium stays at $1723 if I put in 3 or 4 members in the household.

I have kids at home and it also says to put in the age of the youngest adult from 19-64. I put in 19 for my son and then the premium goes down to $574. I think they are assuming that if the youngest adult is 19 that the oldest adult is probably close to that age. It doesn't seem to be considering the possibility of older parents with adult kids at home. Just like it doesn't seem to have a concept of someone under 65 being in a household with someone over 65....

Edit: Another thing I did my son at 19 as an individual and it would be $212 a month. So theoretically if my kids could do individual polices that would be $424 a month ($212 each) and I would do $635 as a in individual so the total would be $1059 a month. But if you put in a 3 person family with the youngest adult at 58 and with 2 children under 19 (what is actually the case right now) then it is $1723 a month. Again, that doesn't seem to make sense....

Edit2: Looking at this they are only quoting based upon single person or family of 2 to 8. So this really isn't that useful.

After a quick look at the prices it seems they are in the same ballpark as Mass. Not a surprise.

Not for me. I look at the Mass premiums which for me and dependent children were about $750 a month for a bronze plan (which is most similar to what I have now) and a little more for a silver plan. The Mass. website allows for putting in coverage for one person and dependent kids. Of course that $750 a month is way more than I pay now (on DH's subsidized retiree plan).

 

[samclem]

I thought the insurance companies lobbied heavily against the ACA. Maybe I'm wrong? I didn't follow this too closely.

Without getting too political, I think there's general agreement that they reached an agreement with the White House early in the process and lobbied hard for PPACA once they were guaranteed that every American below the age of 65 would be induced by the government to be their customer. Many opponents of PPACA as it was written felt the insurers had made an underhanded deal, and there was very little sympathy for them--from anyone--when they got cold feet very late in the process when "cost controls" were beefed up slightly.

 

[mpeirce]

The ACA does limit the medical loss ratio. Basically insurers can't get more than 15-20% profit. I thought some posters here already reported that insurers had to give back some of their premiums.

My understanding is that this is how they intend to kill off HDHP w/ HSAs.

With traditional "medical coverage" you pay premiums and all your covered medical expenses are paid by the plan (minus copays in some cases).

In the HDHP/HSA setup, you pay for your medical expenses yourself until you hit the deductible. Its much more like medical insurance rather then a medical plan. Since this money isn't routed through the insurance company, it's not counted toward their ML-Ratio.

The PPACA now triggers a rebate in many cases where the high deductible hasn't been reached. Of course, the companies need this "outrageous high profit" from these cases to cover the expenses when the real insurance kicks in.

If we can get the law changed to include the money people pay for their own care as part of the ML-Ratio, we might be able to save HDHP/HSA plans.

 

[anethum]

There are so many things wrong with the current health insurance situation that something had to be done. Is the solution ideal? No, the bill that passed certainly would not have been my first choice. But it is a big step forward from the disgraceful situation we have now where millions have no insurance, millions cannot get insurance, and a shockingly large number of others who need significant medical care have inadequate insurance and eventually are forced into bankruptcy.

Massachusetts has had several years of experience with their very similar plan. Most residents support it, and the level of support has increased since it first went into effect. Although I've never lived in Massachusetts, I worked for a Massachusetts-based company and my insurance was through Blue Cross of Massachusetts when their state law went into effect. The cost of my health insurance actually dropped.

 

[M Paquette]

Thanks for that link. After a quick look at the prices it seems they are in the same ballpark as Mass. Not a surprise.

Officially, now that California has the benefits laid out for each of the four exchange plans, bidding starts for what will be in the exchange in October 2013. The current prices that the estimator comes up with don't have the (not yet filed) bids figured in yet. I think they are just using prices for current individual insurance plans that have benefits similar to the new Silver Plan.

Those of us not seeing the doctor all that often, and on relatively few prescriptions, might have better overall expenses (insurance + deductibles + copays) on a Bronze plan, which looks more like a high deductible plan. If our income is too high for subsidies, sticking with a current high deductible plan might be the best deal of all.

 

[ziggy29]

Massachusetts has had several years of experience with their very similar plan. Most residents support it, and the level of support has increased since it first went into effect. Although I've never lived in Massachusetts, I worked for a Massachusetts-based company and my insurance was through Blue Cross of Massachusetts when their state law went into effect. The cost of my health insurance actually dropped.

I remain skeptical, but I do hope it works out. I hope to never be of the mindset where I want public policy to fail because it may not completely jibe with my own political/ideological preferences.

 

[ziggy29]

Without getting too political, I think there's general agreement that they reached an agreement with the White House early in the process and lobbied hard for PPACA once they were guaranteed that every American below the age of 65 would be induced by the government to be their customer. Many opponents of PPACA as it was written felt the insurers had made an underhanded deal, and there was very little sympathy for them--from anyone--when they got cold feet very late in the process when "cost controls" were beefed up slightly.

My understanding is that the insurers made it very clear that they *supported* a guaranteed issue, zero-underwriting system with no preexisting condition exclusions as long as they were allowed to price their product profitably and there was a true universal mandate (to avoid adverse selection).

Many of the insurers don't like how cheaply people can "go naked" and pay the fines, only to buy in once they start developing health problems. In other words, the fines (or taxes based on the SCOTUS decision) are not sufficient to enforce a universal mandate, and thus there is still the potential for too much adverse selection with younger and healthier folks opting out and paying the fine/tax.

 

[M Paquette]

My understanding is that this is how they intend to kill off HDHP w/ HSAs.

With traditional "medical coverage" you pay premiums and all your covered medical expenses are paid by the plan (minus copays in some cases).

In the HDHP/HSA setup, you pay for your medical expenses yourself until you hit the deductible. Its much more like medical insurance rather then a medical plan. Since this money isn't routed through the insurance company, it's not counted toward their ML-Ratio.

The PPACA now triggers a rebate in many cases where the high deductible hasn't been reached. Of course, the companies need this "outrageous high profit" from these cases to cover the expenses when the real insurance kicks in.

If we can get the law changed to include the money people pay for their own care as part of the ML-Ratio, we might be able to save HDHP/HSA plans.

The rebate only kicks in when the plan-wide spending, across all members of a plan, drops below 80% of revenue. The expenses for an individual or a family may be much farther below the amount that they pay for insurance in a particular period, but some other member might have expenses far higher than their premiums. That's the risk-sharing aspect of insurance.

 

[FIREd]

Officially, now that California has the benefits laid out for each of the four exchange plans, bidding starts for what will be in the exchange in October 2013. The current prices that the estimator comes up with don't have the (not yet filed) bids figured in yet. I think they are just using prices for current individual insurance plans that have benefits similar to the new Silver Plan.

Those of us not seeing the doctor all that often, and on relatively few prescriptions, might have better overall expenses (insurance + deductibles + copays) on a Bronze plan, which looks more like a high deductible plan. If our income is too high for subsidies, sticking with a current high deductible plan might be the best deal of all.

Based on the Covered California calculator, subsidies go away once our income goes over $60K, which is not very much for our high COL area. Does anyone know if there will be any regional adjustment to the subsidies based on COL? Otherwise, it would be better to retire on $60K or less in a low COL area.

 

[Mulligan]

My understanding is that this is how they intend to kill off HDHP w/ HSAs.

With traditional "medical coverage" you pay premiums and all your covered medical expenses are paid by the plan (minus copays in some cases).

In the HDHP/HSA setup, you pay for your medical expenses yourself until you hit the deductible. Its much more like medical insurance rather then a medical plan. Since this money isn't routed through the insurance company, it's not counted toward their ML-Ratio.

The PPACA now triggers a rebate in many cases where the high deductible hasn't been reached. Of course, the companies need this "outrageous high profit" from these cases to cover the expenses when the real insurance kicks in.

If we can get the law changed to include the money people pay for their own care as part of the ML-Ratio, we might be able to save HDHP/HSA plans.

Having a HD plan that is very cheap, I share your concern. Mine is under the legal $6k limit, so it can continue, but the loss ratio is a deep concern to me for its long term viability. HSA's are going to be around, but in what form.... I have searched and searched and have not found anything on internet that states the maximum HSA deduction for 2014. In years past, you always knew what the following years limit would be. I am afraid they are going to lower the limit to coincide with the new plan deductibles.

 

[ziggy29]

I have searched and searched and have not found anything on internet that states the maximum HSA deduction for 2014. In years past, you always knew what the following years limit would be. I am afraid they are going to lower the limit to coincide with the new plan deductibles.

Last year, the 2013 limits weren't released by the IRS until April 27.

 

[Mulligan]

Last year, the 2013 limits weren't released by the IRS until April 27.

Maybe I was just reading estimates on some HSA material websites then, as I have never looked on IRS for info. That makes me feel better that maybe it will continue to go up. But I can't seem to find any information on them concerning the actual impact the healthcare act will have on them, dollar wise.

 

[ziggy29]

Maybe I was just reading estimates on some HSA material websites then, as I have never looked on IRS for info. That makes me feel better that maybe it will continue to go up. But I can't seem to find any information on them concerning the actual impact the healthcare act will have on them, dollar wise.

I suspect the folks who usually "jump the gun" with estimates have very little certainty about what the IRS will do with this starting in 2014 when PPACA takes (more or less) full effect, so they are hesitant to stick their necks out as in past years.