Healthcare insurance and retirement - again!

[razztazz]

Better jobs provide healthcare. Service jobs typically do not.

That's the response I was expecting

There is nothing about manufacturing jobs that make them better jobs or pay more or provide medical insurance

Those jobs used to be dirt bag, low pay, no benefit jobs and can be again. There is nothing inherent in manufacturing jobs that makes them that different. The reason why the attained that high degree of desirability is because they got unionized. Non manufacturing jobs can do the same but it's all one-way there.

That's all I will say simply to clarify why I asked the question. I want this to stay on INSURANCE and not stray

 

[Big_Hitter]

I suspect merely allowing selling across state lines is not going to lead to the "acceptable level of nirvana" people think it implies. My reason for thinking this is: If it was good they'd have been doing it already. Now, there might be some fairly simple techniques applied to make it work, but again those closer to the business would know better

the reason they aren't doing it already is that it's illegal

 

[Teacher Terry]

Sue, if you take SS early you can't get Medicare early. To my knowledge you must be 65. Ryan was on TV today stating that one of the first things they will work on is repealing the ACA. I think they will repeal it with no replacement. I am so glad I have retiree insurance from my employer even though it is really expensive.

 

[exnavynuke]

I don't see why Congress wouldn't just repeal the ACA. They've tried over 50 times. Now they can finally do it. They don't even have to bother with a replacement.

Don't you think they will seriously consider this approach? I do. What's stopping them?

There's a lot of voters (millions) that are happy they can get insurance now who couldn't prior to the ACA. Politicians don't generally try to have press showing people saying "thanks to what they did, my grandma is homeless because she couldn't get insurance that she had before they screwed up the law and so her medical bills took everything from her" etc.

The ACA brought "uninsurable people" (who need insurance the most, often older people, cancer patients, etc) insurance. A straight repeal would effectively take that away from them. That would be a political nightmare that would likely cost many politicians their seats the next time they were up for election. As such, I think a complete repeal, without a replacement of some kind, is highly unlikely.

 

[gauss]

My concern is the return of medical underwriting when determining individual premiums in the individual (ie non-group) market.

If there are no limits on this then we are not really purchasing "insurance", but rather "group purchasing." for medical services.

If the individual mandate is repealed, it would be difficult to avoid this.

-gauss

 

[Senator]

Blanket legislative exemption from tort claims? I don't see that surviving.

Barring blatant malpractice, if a doctor was doing his best, why be able to sue for millions? Perhaps a schedule, like a life insurance schedule, could be adopted.

Doctors will make mistakes, and the payouts will show up in the premiums. Eliminate the payouts, and you reduce the premiums.

 

[Sue J]

Sue, if you take SS early you can't get Medicare early. To my knowledge you must be 65. Ryan was on TV today stating that one of the first things they will work on is repealing the ACA. I think they will repeal it with no replacement. I am so glad I have retiree insurance from my employer even though it is really expensive.

Yeah, of course I know that.

What I'm saying is that if insurance costs are based on ACA MAGI, and I don't need the income from SS, I would wait to take SS at 65 (or my FRA of 66 and 2 mo).

I don't need to take SS early unless it's to pay for non ACA insurance before I reach Medicare age.

 

[audreyh1]

I'm confused... Did no one ER before ACA? Just asking...

Some of us had to join state risk pools to get insurance that would cover pre-existing conditions (even for the most trivial things) - but only if we came from a job had provided health insurance coverage for 18 months, and that depended on the state.

The state risk pools disappeared when the ACA went into effect.

 

[explanade]

Insurers can't or won't keep premiums the same within a state like CA.

Selling across state lines won't matter because it will be priced based on zip code. Some markets have fewer provider networks so prices are going to be higher in those markets, regardless of the law.

I hope CA passes some state law but without the Feds paying for Medicaid expansion and subsidies for lower middle income folks, it may not be useful.

 

[explanade]

Barring blatant malpractice, if a doctor was doing his best, why be able to sue for millions? Perhaps a schedule, like a life insurance schedule, could be adopted.

Doctors will make mistakes, and the payouts will show up in the premiums. Eliminate the payouts, and you reduce the premiums.

Several states imposed malpractice caps.

The premiums were not lower than neighboring states nor was there some mass migration of doctors to those states with caps.

Malpractice added very little direct costs to overall health care spending. Maybe not even 1% IIRC. But there were claims of very high "defensive medicine" costs which were never really quantified.

There better be a lot more to the "replace" than "tort reform!"

 

[MichaelB]

A reminder to avoid campaign rhetoric and party proposals that are not part of a legislative effort.

Also, a request to please stay on topic.

 

[Pilot2013]

That's the response I was expecting

There is nothing about manufacturing jobs that make them better jobs or pay more or provide medical insurance

Those jobs used to be dirt bag, low pay, no benefit jobs and can be again. There is nothing inherent in manufacturing jobs that makes them that different. The reason why the attained that high degree of desirability is because they got unionized. Non manufacturing jobs can do the same but it's all one-way there.

That's all I will say simply to clarify why I asked the question. I want this to stay on INSURANCE and not stray

Sorry, but that's just not true, and unions (required at one time, but a burden now) are why the manufacturing jobs have been depleted. I guarantee, if you look at the median wage for manufacturing vs. service jobs, it is a large disparity. And yes, the benefit side is a large disparity as well.

 

[RetireAge50]

When we retire next year we will be able to pay for retiree health insurance at employer cost. For us a married couple this currently is $1,115/mo. I'll check this against whatever else is available.

 

[Teacher Terry]

R50:, if you decide not to go with employer insurance I would make sure you can pick it up in the future if you want. I retired from the state and if we let ours go we can't get it back.

 

[CaliforniaMan]

I don't see why Congress wouldn't just repeal the ACA. They've tried over 50 times. Now they can finally do it. They don't even have to bother with a replacement.

Don't you think they will seriously consider this approach? I do. What's stopping them?

I don't see them doing that. Before, they could vote anyway they wanted, to appease their base, because they knew it would not become law.

Now they are writing a real law, they will have to consider the consequences. So I suspect (hope?) it will be a well thought out change.

Two things are popular about the current law, covering pre-existing conditions, and covering kids to 26. They will probably want to keep those, but how you do that without a mandate is beyond me.

Will be interesting to watch the struggle.
I own some Vanguard healthcare funds, they are up a lot today.

 

[exnavynuke]

Barring blatant malpractice, if a doctor was doing his best, why be able to sue for millions? Perhaps a schedule, like a life insurance schedule, could be adopted.

Doctors will make mistakes, and the payouts will show up in the premiums. Eliminate the payouts, and you reduce the premiums.

I don't have a problem with tort overhaul to eliminate ridiculously high emotional awards in tort claims (one of the large reasons for massive malpractice insurance premiums imo) or to restrict nuisance suits (including suits where no evidence shows anyone did anything wrong, even though there was a negative outcome). That's a far cry from not allowing suits at all though.

I've long believed that tort overhaul would go a long way toward reducing costs of health care and wasted time/money. How many tests are ordered on the 0.00001% chance it might be that other diagnosis just to avoid potential lawsuits if the 99.99999% confidence it was in fact the obvious diagnosis was wrong? That all costs money and goes towards increased healthcare costs which drives up health insurance costs. The cost of the malpractice insurance is small compared to the costs of CYA medicine practice I'd imagine.

 

[Big_Hitter]

the real reason that they won't repeal the entire law is that the Rs in the senate no longer have the 60 votes necessary to block a filibuster from the Ds

if they move to repeal ACA in its entirety the Ds will just filibuster

 

[exnavynuke]

Several states imposed malpractice caps.

The premiums were not lower than neighboring states nor was there some mass migration of doctors to those states with caps.

Malpractice added very little direct costs to overall health care spending. Maybe not even 1% IIRC. But there were claims of very high "defensive medicine" costs which were never really quantified.

There better be a lot more to the "replace" than "tort reform!"

I think the "defensive" costs are hard to quantify because it's tough to quantify or determine which tests or procedures would not be done if a doctor or administration wasn't afraid of being sued if they turned out to be wrong.

 

[scrabbler1]

the real reason that they won't repeal the entire law is that the Rs in the senate no longer have the 60 votes necessary to block a filibuster from the Ds

if they move to repeal ACA in its entirety the Ds will just filibuster

I would normally agree with you but remember that the ACA was originally passed in part without needing 60 votes in the Senate because Reid used a senate rule to bypass the 60-vote requirement (Scott Brown had just won the MA Senate seat, reducing the Dems to 59 senators). Couldn't the crafty McConnell use the same tactic to repeal it?

 

[MichaelB]

Let's please stay away from the politics.

 

[Big_Hitter]

Let's please stay away from the politics.

sorry I was just trying to state why I don't think ACA will be repealed in its entirety - it's not very clear to most

changes will have to be made relatively slowly - the process to dismantle ACA is complicated and will not be immediate

 

[pb4uski]

Why do you think that preexisting conditions will be OK in the future? I'd love to share that viewpoint, but I'm thinking the insurance companies want to quantify their risks. ...

Two reasons. First, the elimination of medical underwriting is hugely popular with the public. Second, Speaker Ryan's proposal prohibits both medical underwriting and rescission of policies on renewal for those who have been sick. That should be enough.

Finally, it doesn't matter what the insurance companies want, what matters is what the public and politicians will allow.

 

[pablo]

When I retired last year I stayed on my expensive COBRA plan even though I now qualify for generous ACA subsidies. I've been concerned about an ACA implosion or outright repeal and didn't want to lose access to HI (I do like my COBRA plan even if it is crazy expensive) since it is unknowable what HI would look like port-ACA. I'm in NY State so I do get 36 months for COBRA. 23 months left to go and I have a bad feeling about this.

Republicans have two plans that they've proposed. One has a refundable tax credit involved and one is related to tax treatment of employer payments for HI. Sadly, it seems that existing non-employee situations (us!) hasn't been well-thought out or even considered. And as to pre-existing conditions - who knows? It's all on the table. Ultimate outcome is wiiiiide open and unknown.

As far as a filibuster - it won't work since the ACA is classified as a budget item and would be part of a straight up/down vote in the budget process. No filibuster for that.

 

[pablo]

sorry about the politics!

 

[easysurfer]

I don't see why Congress wouldn't just repeal the ACA. They've tried over 50 times. Now they can finally do it. They don't even have to bother with a replacement.

Don't you think they will seriously consider this approach? I do. What's stopping them?

Or they might leave a lot intact, but just give it a new name and claim credit for making "progress".

I'm both nervous and excited about what the future holds.