Healthcare insurance and retirement - again!

[ziggy29]

pre-existing conditions and kids to age 26 will remain

I think these two provisions are, far and away, the most popular ones in the ACA as we know it today. I think these will be the hardest "sell" to the people to try and take away.

The question is, what replaces the rest of it? What is the funding mechanism that can make these popular provisions fiscally feasible without an individual mandate or subsidies/tax credits for the poor and middle class?

 

[ziggy29]

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?

IMO, at least three of the provisions of the ACA -- ban on preexisting condition exclusions, elimination of medical underwriting and keeping kids on the policy until age 26 -- are too popular for them to repeal everything with one fell swoop. They may replace almost all of the "guts" of the ACA with another mechanism, but I think these provisions would survive.

I wouldn't expect to see any changes take effect until 1/1/2018, even if legislative action took sooner.

 

[MRG]

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.

@pb4uski Thanks that makes sense.

One could imagine a new name for parts of the new law that were brought forward. Then add, change and delete a few bits and suddenly it's shiny and brand new. There is room to improve the next version. Developed by the right team so to speak. We had a name for it in IT, NIH(not invented here). I've seen multiple million dollar software development dollars spent on NIH.

 

[Corporateburnout]

I would prefer moving to MA or some place in the U.S. for 6 months and a day for residency as a plan B if the pre-existing condition clause makes a come back, but I am not as sure that reverting back to Romneycare will be possible.

April through October weather's is pretty nice around here and won't be a shock to your system.

The Boston Globe had an article back when the ACA had its difficulties quoting officials about the state reverting back to its law if the ACA was repealed. I could not find the link but I 'm sure this will be discussed quite a lot on our local news in the next few months.....

 

[deskpilot]

Repealing ACA still leaves HIPAA in force (I think). So, access to individual coverage would still be guaranteed, given 18 months of continuous coverage.

My wife has a pre-existing condition. So, I am concerned just how high the premiums will be.

Pre-ACA, were the high risk premiums just unaffordable?

 

[MRG]

Repealing ACA still leaves HIPAA in force (I think). So, access to individual coverage would still be guaranteed, given 18 months of continuous coverage.

My wife has a pre-existing condition. So, I am concerned just how high the premiums will be.

Pre-ACA, were the high risk premiums just unaffordable?

HIPPA is all about the privacy of your medical records. What is a breach? What data is confidential? What happens if a breach occurs..

ACA gave everyone the ability to purchase insurance without regard to prior medical issues. Among other things. They're really not related.


Pre ACA state I lived in there was a state high risk pool. It was considered expensive and very limited by the folks I knew that were on it. You also had to be uninsured for 6 months before you could apply. Of course that's all gone now.

 

[kimcdougc]

I have been on ACA since Sept of this year. Paid $1589 for gold plan. Get a notice in the mail that my plan will no longer be offered. Looked into another gold plan (I have a pre existing condition) and the monthly fee would be $1,980 per month with a $1,000 deductible. Too much for my pocket book. So, I chose a silver plan with a $2,500 deductible per person for $1,390 per month for less care.

All of these plans are like paying a house note. This is why we sold our house and got a smaller place we rent so we could afford health care. Still can't afford it but what does one do? We will just have to wait and see what happens.

 

[ziggy29]

HIPPA is all about the privacy of your medical records. What is a breach? What data is confidential? What happens if a breach occurs..

ACA gave everyone the ability to purchase insurance without regard to prior medical issues. Among other things. They're really not related.

Actually one of the aspects of HIPAA *was* the guaranteed issue of policies without preexisting condition exclusions if you had 18 months of creditable coverage immediately preceding. ACA has largely rendered that aspect of the law obsolete, but it could become relevant again.

It also didn't prevent medical underwriting, so it didn't do anything to ensure the premiums were affordable and not everyone was in the same pool.

 

[Which Roger]

I don't see anything significant happening quickly. Any changes will require either near-unanimous support from the majority party, or bi-partisan support. "Just repeal" won't fly, and "Repeal and replace" will take a lot of effort to come up with a suitable replacement. The "replacement" may end up looking more like an improved version of what we currently have in place.

 

[Sojourner]

I agree that whatever happens will happen pretty gradually, considering how complex the ACA is and how much partisan disagreement there will be about its "replacement". However, it is true that a with majorities in both houses, the Congress could pass legislation with no filibuster impediment if they use the rules of "budget reconciliation". I suspect we may see something like that. The question is, how much of a dismantling and potential replacement will there actually be. Hopefully cooler heads will prevail and we'll get something reasonable that works for most people.

 

[Sojourner]

On a practical note, I'm wondering what could happen if someone chooses to receive their premium subsidies directly during 2017 as opposed to getting the subsidy on their 2017 tax return (in April 2018). If the ACA is dismantled in some form or fashion next year, might that affect being able to receive the subsidy in April 2018? Might it be safer to go ahead and receive the subsidies as reduced monthly premiums in 2017? Or does it make no difference, since the ACA and all its tax implications are already "baked into the cake" for 2017 and can't be changed even if lawmakers tried to?

 

[NW-Bound]

It looks like we may have a new opportunity to discuss health care insurance and early retirement. ...

Did you use the right emoticon?

Tell y'all the truth, the last time this issue was stirred up, I did not pay that much attention. You see, I was smug and happy with a pre-ACA policy that was not really cheap, but quite affordable without any subsidy. But now, I have that "preexisting condition", and am in the same boat as many of ya.

So, misery loves company. Together, we'll see what happens next. "If it's not one thing, it's 'nother".

 

[HadEnuff]

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 think it may be one thing to put the legislation on the desk of a prez you know will veto it, and another thing to put the legislation on the desk and then be responsible for the outcomes.
I don't know how this will play out, but as usual, the uncertainty makes it difficult-to-impossible to plan our lives very well. However, I am proceeding in exactly the same manner as I would have regardless of the outcome of the election. Just signed up for my ACA plan, and hope the subsidy I'm planning on will still be allowed at tax time. Either way, I gotta have the insurance.

 

[MRG]

Actually one of the aspects of HIPAA *was* the guaranteed issue of policies without preexisting condition exclusions if you had 18 months of creditable coverage immediately preceding. ACA has largely rendered that aspect of the law obsolete, but it could become relevant again.

It also didn't prevent medical underwriting, so it didn't do anything to ensure the premiums were affordable and not everyone was in the same pool.

Thank you I didn't know that.
All those years of getting certified in HIPPA didn't teach me crap about the law other than knowing how Megacorp could fire me for breach.

 

[audreyh1]

Actually one of the aspects of HIPAA *was* the guaranteed issue of policies without preexisting condition exclusions if you had 18 months of creditable coverage immediately preceding. ACA has largely rendered that aspect of the law obsolete, but it could become relevant again.

It also didn't prevent medical underwriting, so it didn't do anything to ensure the premiums were affordable and not everyone was in the same pool.

No - no guaranteed issue! Maybe in some states, but in TX an insurance company just flat out denied anyone with pre-existing conditions, and your only recourse was the state risk pool.

 

[ziggy29]

However, I am proceeding in exactly the same manner as I would have regardless of the outcome of the election. Just signed up for my ACA plan, and hope the subsidy I'm planning on will still be allowed at tax time. Either way, I gotta have the insurance.

I would do the same. That said I would make sure I was mindful that things could be very different in 2018 and start preparing for a Plan B. I suspect you will be fine for 2017, but of course there are no guarantees.

 

[daylatedollarshort]

Repealing ACA still leaves HIPAA in force (I think). So, access to individual coverage would still be guaranteed, given 18 months of continuous coverage.

My wife has a pre-existing condition. So, I am concerned just how high the premiums will be.

Pre-ACA, were the high risk premiums just unaffordable?

We had a COBRA policy that we converted when COBRA ran out and I believe the conversion was possible due to HIPAA laws. It has been a few years now so I don't remember the exact amounts but the premiums were around $2300 a month with high deductible and out of pockets. However, for one high medical expense year for us our out of pocket costs (in addition to premiums) were on the order of $20K instead of the $150K they would have been with no insurance at all (~$50K all in).

$50K for medical care per year? I think for that kind of money we'd move to Mexico or some other country with much lower health care costs and spend the money on travel instead. We were considering doing that pre-ACA anyway.

 

[audreyh1]

Thank you I didn't know that.
All those years of getting certified in HIPPA didn't teach me crap about the law other than knowing how Megacorp could fire me for breach.

Check my reply to Ziggy

 

[Potstickers]

The high-risk pool in our state had a cap on enrollment, so people who wanted into it could be turned away for years AND you had to go without health insurance for six months to be eligible. Truly a marvel.

 

[bamsphd]

Actually one of the aspects of HIPAA *was* the guaranteed issue of policies without preexisting condition exclusions if you had 18 months of creditable coverage immediately preceding. ...

If you took a job which provided health insurance, that health insurance had to cover preexisting conditions if you had 18 months of creditable coverage immediately preceding.

If you then FIREd in theory the insurance company had to offer you a potentially very expensive individual policy, if they offered individual policies in your state. However, that part had multiple holes. My big Fortune 500 company paid United Healthcare to "administer" their "self insured" company health plan, which meant no guaranteed issue policy was available. I was also turned down by the only company which then issued individual policies in my state.

That left the state's federally mandated High Risk Pool which supposedly had to take people losing Cobra coverage. It did NOT have to take people losing individual coverage, and my understanding is that some states had extremely long waiting lists to get into their High Risk Pools.

In the individual market, if you had creditable coverage and changed HI plans, the new plan had to cover your preexisting condition. However, no insurance company had to agree to take you as a customer. Basically, if you could show you never used insurance, you could buy cheap insurance. If you disclosed that you had been using your insurance, you probably wouldn't be offered insurance at any price. If you didn't disclose all your health issues the insurance company could retroactively revoke your insurance.

Which is why I waited to FIRE until the Supreme Court declared the PPACA was constitutional, and my COBRA coverage could bridge me to the first health exchange open enrollment period.

 

[ziggy29]

No - no guaranteed issue! Maybe in some states, but in TX an insurance company just flat out denied anyone with pre-existing conditions, and your only recourse was the state risk pool.

Yeah, I was unclear in my phrasing. In some states the guaranteed issue *was* the state risk pool -- not that you could go to any insurer and expect them to cover you.

 

[daylatedollarshort]

The high-risk pool in our state had a cap on enrollment, so people who wanted into it could be turned away for years AND you had to go without health insurance for six months to be eligible. Truly a marvel.

I checked into that and pre-ACA and had the same findings. One bad car accident and six months, let alone years, without medical care in the U.S. could rack up millions in bills.

HIPAA guaranteed continued coverage for some with previous policies and pre-existing conditions but did not cap the price. So we could do away with pre-existing coverage clauses with the ACA repeal but what is to stop insurers from charging $10K a month for insurance if there are no price caps in place?

 

[bamsphd]

If the ACA is dismantled in some form or fashion next year, might that affect being able to receive the subsidy in April 2018? Might it be safer to go ahead and receive the subsidies as reduced monthly premiums in 2017? Or does it make no difference, since the ACA and all its tax implications are already "baked into the cake" for 2017 and can't be changed even if lawmakers tried to?

First the federal government has a long history of retroactively changing its tax laws. So don't count on it being "baked into the cake."

If you took up front tax subsidies and the congress had eliminated those tax subsidies by the time you filed your taxes, you might find yourself paying back those subsidies. I like to hope they would at least means test an exception to paying back subsidies, but they wouldn't have to.

 

[RockyMtn]

Two ideas...

1. Allow people to "buy up" to Medicare at age 62 similar to buying pension credits.
2. An insurer should only be allowed to offer Medicare plans if they are also offering ACA or it's successor plans.

 

[pb4uski]

True that there is a history of retroactive changes, but in most cases retroactive changes are changes in favor of the taxpayer. Retroactive changes that are adverse to the taxpayer are remote... in fact, I can't think of any.