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/dont-call-it-a-mandate-its-a-tax/

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/c...ve-choice-whether-to-join-medicaid-expansion/

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]

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]

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]

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]

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]

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]

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.

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]

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]

.....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]

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.

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]

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

 

[Sue J]

I'm very happy that this was upheld. I'm looking at this personally because I'm losing my health care coverage on 1-1-14.

DH is retired from public employment. Our health care coverage comes from his pension plan. He gets a very generous allowance based on his years of service and I get a smaller amount also based on his years of service. There are 3 levels of coverage and we chose the lowest cost/lowest coverage option.

When he lost his job in 2010 and we looked into the option of retiring, health care coverage was, of course, a major issue. I had researched the health care coverage and we asked specific questions when we met with the counselor. We knew that the health care coverage was not mandated or guaranteed but they had been providing it since 1962 and they intend to continue to provide it. We fully expected the cost to go up and the coverage to go down. No problem, we can absorb that. In fact, we planned for it.

Soon after DH retired the subsidy for spouses under 55 was eliminated, though a spouse could still be covered and pay the full amount, $615-$807/mo. I was already over 55 so that didn't affect us.

In April 2012 it was announced that health care coverage needed to change. The money comes from a portion of the employer contribution side (not the employee contribution side, that all goes to the pension) and the earnings off of the investments from that portion. Between low investment return, huge increases in health care costs, more people retiring early due to the recession and reduced employment in public jobs they are projecting that they can no longer afford to provide health care insurance for spouses. Many of us have asked if we could have access to coverage and just pay the full premiums ourselves and the answer is NO. This is the largest pension plan in Ohio, over 185,000 retirees (plus spouses). You'd think they could include spouses get a good group rate!

The pension system provides a blog where they post articles and updates and a moderator will answer most of the questions. People are shocked and angry over losing spousal coverage. The pension system is holding Town Hall meetings around the state and you can find the presentations online. They say that they are still considering options but I think they have already decided and that it's a done deal.

It's a matter of income vs outgo. They want to protect the health care benefits for the retiree who worked and paid into the system and at this point they cannot continue to cover spouses. I am a very practical LBYM person so I get it! It's just hard to accept that my DH will be covered and I am eliminated/dropped/left to fend for myself for something as important and EXPENSIVE as health care insurance. All my adult life DH and I had health care coverage through an employer, either mine or his. We've never been in the position of one of us being excluded from coverage.

My part-time job doesn't have any benefits except a "mini-medical" plan that is worthless. It covers 2 office visits and up to $1500 in claims per year. That's useless for any kind of illness.

So I know there will be folks who think the PPAC is evil and socialist and that it will be the beginning of the end for our country. I can't judge the impact. I'm just one little spouse who is being dumped off a cliff in about 18 months. I'm glad this is upheld and I hope it all works out to be a positive change for the country.

If you are interested in the issue of a state pension plan eliminating coverage for spouses, the plan is Ohio Public Employees Retirement System and 2 of the topics on the blog where they are discussing the changes to the health care plan are here -
Health care plan details to be decided this fall | PERSpective
OPERS details potential changes to health care | PERSpective

 

[M Paquette]

It's a relief for me, as I don't have to worry about recission for something I might have missed on the application, and I'll have guaranteed renewal on January 1, 2013, as the ACA is unlikely to be repealed before then. (I worry about cr*p like this: http://edition.cnn.com/2009/POLITICS/06/16/health.care.hearing/ )

A new state law (currently being challenged in the court, of course) will ban recission for accidental omissions in applications, restricting it to fraud or "intent to deceive" and requiring approval of the state insurance commission, will be in effect before ACA could be repealed.

So, it looks like I'll have individual coverage for myself and my family through 2013. I guess that makes me a socialist, since insurance is just spreading risk and expense over a pool of strangers.

 

[ziggy29]

My part-time job doesn't have any benefits except a "mini-medical" plan that is worthless. It covers 2 office visits and up to $1500 in claims per year. That's useless for any kind of illness.

In fact, that's the exact *opposite* of what insurance is supposed to be. Insurance generally covers you against huge, financially devastating losses while expecting you to "self-insure" a modest amount (the deductible). What you have is exactly the opposite -- covers the first small amount of loss, then leaves you exposed to unlimited financial devastation.

 

[eytonxav]

I'd be a lot more supportive of the law if it was mandatory for all, without all the union/state/law maker exceptions.

Also, the so called coverage of kids up to 26 under their parents plan is not universal either as it does not apply if your parent happens to be covered under a retiree health plan vs an active employee plan (unless your former company does so out of the goodness of its heart).

 

[Sue J]

In fact, that's the exact *opposite* of what insurance is supposed to be. Insurance generally covers you against huge, financially devastating losses while expecting you to "self-insure" a modest amount (the deductible). What you have is exactly the opposite -- covers the first small amount of loss, then leaves you exposed to unlimited financial devastation.

Yeah, I don't think anybody buys the mini-medical. It's just a way for an employer to say they offer "health care coverage". It doesn't cost the employer anything as the full premium is paid by the employee. This was offered to me by H&R Block and also Live Nation for part -time employees.