Patient Protection and Affordable Care Act

[MichaelB]

The PPACA has a major impact on us – forum members with a desire to retire early. The Supreme Court ruling affirms it is constitutional and remaining provisions will now be implemented.

Here is a short summary of the Supreme Court ruling this morning from SCOTUSblog

http://www.scotusblog.com/2012/06/do...ate-its-a-tax/

Quote:

Don’t call it a mandate — it’s a tax Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial — feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.

http://www.scotusblog.com/2012/06/co...aid-expansion/

Quote:

Court holds that states have choice whether to join medicaid expansion The Court’s decision on the constitutionality of the Medicaid expansion is divided and complicated. The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.

Timeline for implementation is here Implementation Timeline - Kaiser Health Reform

We welcome a hearty discussion about the implementation of the PPACA and how that affects us. Everyone knows this issue is very related to FIRE. Focusing on partisanship and ideology rather than the law itself or how this impacts the quest for FIRE would not be keeping with the spirit of community rules, so let’s avoid the politics, positions of individual elected officials or how that affects upcoming elections.

[huusom]

Finally, I can start the count down to 2014.

[ziggy29]

Quote:

Originally Posted by huusom Finally, I can start the count down to 2014.

Or, if you have the money for COBRA, many folks can start a countdown to July 2012, 18 months out from the implementation of most provisions of the act -- T-minus three days....

[ziggy29]

One interesting, and even a bit ironic, note about the decision is that many early supporters of PPACA were on the defensive saying "it's not a tax, it's not a tax" with respect to the mandate and the penalties for those who don't carry insurance. And the legal arguments defending the law mostly relied on the commerce clause. But in the end, Chief Justice Roberts sided with the majority NOT because he was swayed on the government's commerce clause argument, but because the penalty was, indeed, a tax -- which government has long held the power to levy. In other words, a concept that many of the law's proponents rejected (that it was a tax) turned out the be the concept that allowed it to survive the legal challenge.

If nothing else, this reinforces my goal of being "asset rich and income poor" in retirement. Okay, not *poor* -- but low income enough to fly under the radar where means-tested entitlements and health insurance subsidies are concerned.

[cc3159]

Would it be possible for someone to give a brief summary of how this would affect people considering early retirement?

[ziggy29]

Quote:

Originally Posted by Texas Proud Did the other 4 Justices agree that it was a tax From what I have seen so far, they agreed with the mandate under the commerce clause and it was only Roberts who said it was a tax... becoming the 5th vote.... If this is the case, then the supporters will probably still say it is not a tax... just my opinion....

Maybe, but what they say is irrelevant. It was the fifth vote with the majority that mattered, and it was the "power to tax" argument that secured the fifth vote. I doubt they are going to crucify Roberts for calling it a tax.

[scrabbler1]

Now that the law has not been struck down by the Court, will states begin setting up those insurance exchanges for those of us in the individual market will be able to check them out in time for the effective date (1/1/2014?)? Also, is it true that those limited, hospital-only policies will not meet the minimum coverage included in the mandate?

[NW-Bound]

Tax or no tax. Duck or no duck. Being a practical guy, I do not care as I have always bought health insurance. No penalty additional tax for me!

But I need to know how this is going to affect my coverage and my premium. Am still waiting for a spoon-fed summary. Or do I have to read the 1000-page (or whatever?) act that was passed?

[ziggy29]

Quote:

Originally Posted by NW-Bound I guess I need to know how this is going to affect my coverage and my premium.

I think the part about how it will affect your coverage is in the law. The impacts on premiums are, obviously, yet to be seen.

[tomz]

Quote:

Originally Posted by NW-Bound Tax or no tax. Duck or no duck. Being a practical guy, I do not care as I have always bought health insurance. No penalty additional tax for me! But I need to know how this is going to affect my coverage and my premium. Am still waiting for a spoon-fed summary. Or do I have to read the 1000-page (or whatever?) act that was passed?

Try this site. It is a good starting point.

[brewer12345]

Aside from retirees, if the PPACA does get implemented as it was set out over the next 18 months this will provide an opportunity for entrepreneurs and wannabes who have kept the corporate job mainly for the insurance coverage.

[ziggy29]

Quote:

Originally Posted by brewer12345 Aside from retirees, if the PPACA does get implemented as it was set out over the next 18 months this will provide an opportunity for entrepreneurs and wannabes who have kept the corporate job mainly for the insurance coverage.

This, for me, has long been an argument for separating health insurance coverage and employment status. Between the number of folks who would love to unlock their own entrepreneurial streaks and the number of folks who would otherwise be able to retire except for the health insurance problem, I think we have a lot of people who could see the "key" to get out of the golden handcuffs known as Megacorp health insurance.

[NW-Bound]

Quote:

Originally Posted by ziggy29 I think the part about how it will affect your coverage is in the law. The impacts on premiums are, obviously, yet to be seen.

Why do I have the feeling that I will like the additional coverage?
And I hope to be able to afford the premium.

Quote:

Originally Posted by tomz Try this site. It is a good starting point.

Thanks. I have never paid much attention about this, but I'd better invest some time now.

[MichaelB]

Quote:

Originally Posted by NW-Bound Why do I have the feeling that I will like the additional coverage? And I hope to be able to afford the premium.

If your premiums now are large group with employer subsidy or individual with underwriting, it may be painful. OTOH if your premiums are small group unsubsidized they will not likely increase due to the PPACA.

[FinanceGeek]

This is life changing for my family due to pre-existing conditions.

18 months of COBRA to Jan 2014 would be ... Monday

[pb4uski]

Quote:

Originally Posted by MichaelB .....OTOH if your premiums are small group unsubsidized they will not likely increase due to the PPACA.

I'm struggling to understand why no likely increase. Won't small groups also have to bear the costs of not underwriting health insurance? I hope you are right as I have a small group plan (group = me and DW), but I don't see the logic.

[rodi]

Quote:

Originally Posted by cc3159 Would it be possible for someone to give a brief summary of how this would affect people considering early retirement?

It means that in 2014 they can't deny you health insurance for pre-existing conditions.

That means my husbands cholesteral meds won't ban him from insurance. And my family history of cancer and previous pre-cancerous colon polyps won't ban me from insurance.

As Ziggy said - with cobra - we're only a few days away from hitting that sweat spot where we can have insurance to cover us till we hit medicare age.

[NW-Bound]

Mine is an individual HSA with $10K/yr deductible. I guess it is the latter.

Quote:

Originally Posted by MichaelB If your premiums now are large group with employer subsidy or individual with underwriting, it may be painful. OTOH if your premiums are small group unsubsidized they will not likely increase due to the PPACA.

One thing that bothers me about our existing tax laws is that healthcare benefits provided by employers are not taxed, yet my personal insurance premium can only get written off my business income.

If I fully retire and have only unearned income, I will not have this deduction.

Wonder if this changes.

[MichaelB]

Quote:

Originally Posted by pb4uski I'm struggling to understand why no likely increase. Won't small groups also have to bear the costs of not underwriting health insurance? I hope you are right as I have a small group plan (group = me and DW), but I don't see the logic.

If you are in a small group plan your policy is already subject to underwriting and a high risk assessment is applied due to the small group size. In addition you have a large multiplier due to age. The multiplier must decrease - that's part of the law. You will also have available policies in the state exchanges that should be priced to reflect lower risk of larger group.

My expectation is that all policies move toward the average price. This benefits the most expensive, which are current users of small group policies (unsubsidized) and high risk policies.

[grasshopper]

A bright spot if there is one is, I am always $200 short of itemizing. When my existing BCBS premiums go up, and I have to pay out of pocket for preventive checks, it just may take me over the top.NOT