Patient Protection and Affordable Care Act

[ziggy29]

Quote:

Originally Posted by scrabbler1 To prevent people from trying to game the new law by going without insurance, paying the penalty/tax, then buying coverage just when they get sick, could there be a law change which does somethign similar to what is done in the homeowners insurance market: I believe a homeowner has to buy insurance at least 30 days before he can collect on certain types of damage to prevent someone who is without insurance from seeing weather reports of a hurricane approaching and quickly buying a policy. This required lead time could be made longer in the health insurance area but the principle is the same.

It would require an act of Congress to change the new laws. Right now under PPACA this is not allowed to the best of my knowledge.

I'm pretty sure between now and 2014, regardless of what happens in November, there are going to be some legislative efforts to amend or repeal the law (IMO full repeal seems very unlikely for political reasons I won't get into), and at the very least, some "tinkering around the edges".

[samclem]

Quote:

Originally Posted by scrabbler1 To prevent people from trying to game the new law by going without insurance, paying the penalty/tax, then buying coverage just when they get sick, could there be a law change which does somethign similar to what is done in the homeowners insurance market: I believe a homeowner has to buy insurance at least 30 days before he can collect on certain types of damage to prevent someone who is without insurance from seeing weather reports of a hurricane approaching and quickly buying a policy. This required lead time could be made longer in the health insurance area but the principle is the same.

I think this is unrealistic: What Congress is going to pass these measures? The legislators who opposed the present law have announced their intention to get it repealed (not to bandage up its deficiencies), and the legislators who voted for it are unlikely to do anything that would, in effect, deny people the ability to buy insurance.
Nope. It needed to be right from the start.

[scrabbler1]

Quote:

Originally Posted by samclem I think this is unrealistic: What Congress is going to pass these measures? The legislators who opposed the present law have announced their intention to get it repealed (not to bandage up its deficiencies), and the legislators who voted for it are unlikely to do anything that would, in effect, deny people the ability to buy insurance. Nope. It needed to be right from the start.

As someone who worked in the actuarial field for 23 years, I frequently encountered some badly written auto insurance laws designed for political ends even though they made no sense from an actuarial perspective. Sometimes, those laws were tinkered or bandaged, sometimes they were not. I can see some tinkering with the ACA even if it is not to fix this potential problem.

[Bestwifeever]

Quote:

Originally Posted by scrabbler1 To prevent people from trying to game the new law by going without insurance, paying the penalty/tax, then buying coverage just when they get sick, could there be a law change which does somethign similar to what is done in the homeowners insurance market: I believe a homeowner has to buy insurance at least 30 days before he can collect on certain types of damage to prevent someone who is without insurance from seeing weather reports of a hurricane approaching and quickly buying a policy. This required lead time could be made longer in the health insurance area but the principle is the same.

But homeowners who choose not to carry home insurance aren't paying a fine every year they don't carry it. The fines could be construed as a payment for the right to pick up health insurance at any time.

[Midpack]

Quote:

Originally Posted by Mulligan Not unheard of, Midpack. Anyone in MO can get this provided they are healthy. Here is my plan copied right off ehealthinsurance. It is now $76. The healthcare act only raised it $4.

Guess we need to move to MO. Seems odd that everyone else seems to be paying $500-700/mo for high deductible health insurance. What makes MO so different?

[Mulligan]

Quote:

Originally Posted by Midpack Guess we need to move to MO. Seems odd that everyone else seems to be paying $500-700/mo for high deductible health insurance. What makes MO so different?

I looked at an earlier posted link in this thread and it appeared MO insurance companies were rejecting between 35%- 50% of applicants for the various plans. Maybe that was the reason. If I was one of those people, I wouldn't be too pleased. All I know was when I retired I had the option to stay on my group plan and pay the $500 monthly premium and $1k deductible or get on an individual plan. Several of my friends who retired at the same time all jumped on individual plans because they were so much cheaper. None of us got rejected so I don't know what the criteria for rejection was. I did notice the premiums vary from county to county, but there isn't a hospital within 20 miles of where I live so nearby quality care isn't the reason. Maybe its cheaper because they think I will die before I can get medical care.

[Midpack]

Quote:

Originally Posted by Mulligan I looked at an earlier posted link in this thread and it appeared MO insurance companies were rejecting between 35%- 50% of applicants for the various plans. Maybe that was the reason. If I was one of those people, I wouldn't be too pleased. All I know was when I retired I had the option to stay on my group plan and pay the $500 monthly premium and $1k deductible or get on an individual plan. Several of my friends who retired at the same time all jumped on individual plans because they were so much cheaper. None of us got rejected so I don't know what the criteria for rejection was. I did notice the premiums vary from county to county, but there isn't a hospital within 20 miles of where I live so nearby quality care isn't the reason. Maybe its cheaper because they think I will die before I can get medical care.

I don't get it ($864/yr ), but good for you and your friends. It will cost DW and I approaching 10X what you're paying...

[Mulligan]

Quote:

Originally Posted by Midpack I don't get it ($864/yr ), but good for you and your friends. It will cost DW and I approaching 10X what you're paying...

If I had to pay what you and some of the other posters quoted, I simply wouldn't be able to afford retirement and would be simply working for the insurance, like some people have to do I am sure.

[grasshopper]

Quote:

Originally Posted by Mulligan I looked at an earlier posted link in this thread and it appeared MO insurance companies were rejecting between 35%- 50% of applicants for the various plans. Maybe that was the reason. If I was one of those people, I wouldn't be too pleased. All I know was when I retired I had the option to stay on my group plan and pay the $500 monthly premium and $1k deductible or get on an individual plan. Several of my friends who retired at the same time all jumped on individual plans because they were so much cheaper. None of us got rejected so I don't know what the criteria for rejection was. I did notice the premiums vary from county to county, but there isn't a hospital within 20 miles of where I live so nearby quality care isn't the reason. Maybe its cheaper because they think I will die before I can get medical care.

Sometimes uninterrupted HI is a big plus, I think they think that any medical problems would be taken care of by now. Ms. G and I had to show 10 years of certified coverage to get our, not so hot BCBS underwritten. $705 a month younger/61, no exclusions 2.5K each deductible. In network preventative $30 copay.

[Animorph]

I'm retired, DW says she's retiring in mid-2013. So it looks like we can COBRA for half a year until 2014 and ACA kicks in or find underwritten insurance if it is cheaper. Nice to know we have better options now if it turns out insurance companies don't like our heath history.

[ziggy29]

I just had a thought: Since SS income is generally included in the income calculation for determining the subsidy for health insurance, and since the premiums from age 62-64 will be the highest, wouldn't this potentially make a strong argument for waiting to take SS until you are Medicare-eligible? A significant portion of the SS you'd get from age 62-64 would be lost to the reduction in subsidy anyway so you might as well wait until 65* when you will be on Medicare and don't have to worry about private insurance matters any more -- or about the loss of the subsidy.

* -- Or whatever Medicare eligibility age younger folks are going to be moved to. And obviously this likely won't apply to those of you who are blessed enough to have (former) employer-subsidized health insurance in retirement.

[pb4uski]

Makes sense to me but I was planning on waiting until I'm 70 anyway.

[MichaelB]

Quote:

Originally Posted by ziggy29 I just had a thought: Since SS income is generally included in the income calculation for determining the subsidy for health insurance, and since the premiums from age 62-64 will be the highest, wouldn't this potentially make a strong argument for waiting to take SS until you are Medicare-eligible? A significant portion of the SS you'd get from age 62-64 would be lost to the reduction in subsidy anyway so you might as well wait until 65* when you will be on Medicare and don't have to worry about private insurance matters any more -- or about the loss of the subsidy. * -- Or whatever Medicare eligibility age younger folks are going to be moved to. And obviously this likely won't apply to those of you who are blessed enough to have (former) employer-subsidized health insurance in retirement.

Makes lots of sense.

[Purron]

Quote:

Originally Posted by ziggy29 I just had a thought: Since SS income is generally included in the income calculation for determining the subsidy for health insurance, and since the premiums from age 62-64 will be the highest, wouldn't this potentially make a strong argument for waiting to take SS until you are Medicare-eligible? A significant portion of the SS you'd get from age 62-64 would be lost to the reduction in subsidy anyway so you might as well wait until 65* when you will be on Medicare and don't have to worry about private insurance matters any more -- or about the loss of the subsidy. * -- Or whatever Medicare eligibility age younger folks are going to be moved to. And obviously this likely won't apply to those of you who are blessed enough to have (former) employer-subsidized health insurance in retirement.

Great point! DH and I have planned to take SS ASAP, and we're both eligible for pretty big SS payments, but may very well delay if this turns out to be the case. Hope there are more discussions on this point. Perhaps even a new thread in the event this one meets Mr. Porky.

[Midpack]

Quote:

Originally Posted by ziggy29 I just had a thought: Since SS income is generally included in the income calculation for determining the subsidy for health insurance, and since the premiums from age 62-64 will be the highest, wouldn't this potentially make a strong argument for waiting to take SS until you are Medicare-eligible? A significant portion of the SS you'd get from age 62-64 would be lost to the reduction in subsidy anyway so you might as well wait until 65* when you will be on Medicare and don't have to worry about private insurance matters any more -- or about the loss of the subsidy. * -- Or whatever Medicare eligibility age younger folks are going to be moved to. And obviously this likely won't apply to those of you who are blessed enough to have (former) employer-subsidized health insurance in retirement.

+2, great observation, though I am also planning to wait until I'm 70. All the more reason if this plays out as it appears.

[FinanceGeek]

Just wanted to chime in on my elation that this was upheld.

As I have posted previously I work full time, but have been thinking of taking a self funded sabbatical to go back to grad school on a full time basis. My family has expensive pre-existing conditions and so COBRA or our state's high risk plan are the only options for HI.

The college I am looking at attending provides all students with a crappy minimed which I can't make myself ineligible for (yes, I've already asked the administration and their advice was to seek out an alternate institution of higher learning that lacks this gracious "benefit").

So, if I were to leave my job and enroll in this college and remain a student after my COBRA eligibility ends, it would be devastating to my family as I would suddenly be deemed "eligible for group insurance". The minimed would leave us paying huge out of pocket expenses and my family would be ineligible for our states high risk plan. In other words, I would have to drop out of school and go back to work.

Now with the ACA upheld, anytime after Saturday lies within the 18 month period of COBRA eligibility for insurance after which pre-existing condition limitations aren't valid.

Its time to dust off the school books. I am literally finishing off the Statement of Purpose in another window.

[NW-Bound]

I spent a bit of time perusing the site linked by tomz.

Being a casual consumer of health care so far (knock on wood), I am certainly not knowledgeable, but I thought that the largest portion of the current healthcare costs was incurred in hospitalization. If it weren't for that, pfft, I could pay for my annual exams and my once-every-10-year colonoscopy with a few months worth of my current insurance premium, which is a $10K/year deductible policy.

Yet, I do not see what would make hospital stays less costly, more efficient, etc... There is something about electronic record keeping, but is it enough? What am I missing?

PS. I know that the law helps people with pre-existing conditions, but for the nation as a whole, how does this reduce hospitalization costs? By the way, there is something about the costs of drug.

[Midpack]

I found several sites that project higher premiums, this (CBO) is probably the least partisan?

Quote:

Effects on Health Insurance Premiums. Under PPACA and the Reconciliation Act, premiums for health insurance in the individual market will be somewhat higher than they would otherwise be, CBO and JCT estimate, mostly because the average insur- ance policy in that market will cover a larger share of enrollees’ costs for health care and provide a slightly wider range of benefits.8 The effects of those differences will be offset in part by other factors that will tend to reduce premiums in the individual market; for example, purchasers in that market will tend to be healthier than they would have been under prior law, leading to lower average costs for their health care. Although premiums in the individual market will be higher on average, many people will end up paying less for health insurance—because the majority of enrollees pur- chasing coverage in that market will receive subsidies via the insurance exchanges. Premiums for employment-based coverage obtained through large employers will be slightly lower than they would otherwise be; premiums for employment-based cover- age obtained through small employers may be slightly higher or slightly lower.

http://www.cbo.gov/sites/default/fil...egislation.pdf

[donheff]

Quote:

Originally Posted by Midpack I found several sites that project higher premiums, this (CBO) is probably the least partisan? http://www.cbo.gov/sites/default/fil...egislation.pdf

If the CBO is correct will we see slight rises for greater coverage. Not Too bad an outcome.

[ERhoosier]

Quote:

Originally Posted by donheff If the CBO is correct will we see slight rises for greater coverage. Not Too bad an outcome.

But CBO's track record in predictions of health care costs has been dubious at best.
Congressional Budget Office consistently wrong on health-care estimates | The Daily Caller

Only time will tell how much costs will actually rise for any given individual or family.