BEFORE ACA - what did retirees do?

[agh1]

... for many folks, 18 months of COBRA would definitely not be affordable. ACA has currently made this a moot point, but if it is ever dismantled, these provisions of Kennedy-Kassebaum were never explicitly repealed and are still on the books.

At my age, 60+, and in my county, good Cobra robust wide network PPO coverage is less than 1/2 the cost of the cheapest ACA narrow network HMO bronze plan. For the younger crowd, ACA is cheaper but coverage is not as robust.

 

[ziggy29]

At my age, 60+, and in my county, good Cobra robust wide network PPO coverage is less than 1/2 the cost of the cheapest ACA narrow network HMO bronze plan. For the younger crowd, ACA is cheaper but coverage is not as robust.

Yes, I can believe that if you are in a group with a pool of mostly younger workers, since employer group coverage usually does not base premiums on age whereas ACA-compliant individual plans do.

 

[johnhkc]

They submitted cert petitions for SCOTUS to hear the case. They still need the process to be expedited, otherwise it falls outside of the current term. I’m not an attorney and have no idea whether the Supreme Court will agree there is a compelling need to see the case now. A good overview of the process can be seen here https://www.healthaffairs.org/do/10.1377/hblog20200106.206114/full/

If that were to happen, and the lower court ruling upheld, there would be nothing to replace the ACA. Insurers would be free to do pretty much as they wished unless new regulations are passed.

From Politico: "SUPREME COURT WANTS TRUMP's DOJ, RED STATES TO WEIGH IN ON ACA LAWSUIT REQUEST — The high court Monday afternoon asked the Trump administration and Republican-led states challenging Obamacare to quickly respond to the request from Democratic attorneys general to fast track the case, POLITICO's Susannah Luthi reports."

 

[agh1]

Yes, I can believe that if you are in a group with a pool of mostly younger workers, since employer group coverage usually does not base premiums on age whereas ACA-compliant individual plans do.

A group can have bad rates with younger employees as well. Sometimes young employees have very sick children as an example. The smaller the company the bigger the impact on premiums.

 

[johnhkc]

Right! Bingo. You are understanding exactly what I was saying. That was why I didn't take the higher paying, more prestigious, more intellectually challenging job (in the private sector) that was my other option.

This is why I wanted the HSA. It was a major reason why I decided to retire at 39. Since it's group rates and individually owned, I can hop from job to job (if any) without any disruption in health insurance. I can quit, I can be fired, layed off, play video games for 19 months (fun!) or whatever. It has no effect on health insurance. I just have to have the $ to pay the (lower) premiums. All of these employment-tied plans cause so many problems that way.

 

[johnhkc]

Our experience very closely mirrors pb4uski's. What we didn't have with private insurance prior to the ACA was coverage for pre-existing conditions. We didn't have any but once a condition popped up I assume that starting with the next year's coverage the condition could have been non-covered. If I'm correct, this was a big risk we lived with at the time that we do not live with now (actually just my wife since I am not on Medicare). On the other hand, our area's ACA policies now only offer local networks of doctors which exclude the better doctors and clinics. So we are better off in terms of pre-existing conditions but worse off in terms of quality of health care available to us as well as cost of coverage and deductibles.

Before ACA, pre-ex only triggers when you (1) have a medical condition and (2) switch insurance company/plan. As long as you renew your plan, pre-ex stuff is not triggered.
When you first sign up, yes - but after that, no.

Pre-ex exclusions were part of federal law before ACA. These laws were enacted to dissuade people from buying into insurance at the last minute. The idea was that since you can't predict when you'll need it, you should buy now and keep buying it. With an 18-month exclusion window, you won't be able to "predict" when you'll need insurance. If everyone "predicted" this way, there wouldn't be any insurance because there wouldn't be any healthy people to pay for the unhealthy ones.

The same way that the individual mandate was a law to bring people into the pool. Pre-ex laws attempted to do the same.

 

[johnhkc]

I've been using sharing since the mid 1990's, it has worked well for me and my family.

Have you been with the same plan all along? I have CHM Gold. Would you mind telling me which plan you have?

 

[NoMoreJob]

Before ACA, pre-ex only triggers when you (1) have a medical condition and (2) switch insurance company/plan. As long as you renew your plan, pre-ex stuff is not triggered.
When you first sign up, yes - but after that, no.

Pre-ex exclusions were part of federal law before ACA. These laws were enacted to dissuade people from buying into insurance at the last minute. The idea was that since you can't predict when you'll need it, you should buy now and keep buying it. With an 18-month exclusion window, you won't be able to "predict" when you'll need insurance. If everyone "predicted" this way, there wouldn't be any insurance because there wouldn't be any healthy people to pay for the unhealthy ones.

The same way that the individual mandate was a law to bring people into the pool. Pre-ex laws attempted to do the same.

But prior to ACA couldn't the insurance company drop you and if that happened then you would have to on a new plan likely subject to underwriting and with any pre-existing condition excluded?

 

[johnhkc]

But prior to ACA couldn't the insurance company drop you and if that happened then you would have to on a new plan likely subject to underwriting and with any pre-existing condition excluded?

Not with HSA plans - they're all guaranteed renew. In order to be HSA compliant, they had to be guaranteed renewable and group rated. As long as you pay the premium, you're covered. And the premium is group rated so your individual situation won't cause your rates to skyrocket.

 

[NoMoreJob]

Not with HSA plans - they're all guaranteed renew. In order to be HSA compliant, they had to be guaranteed renewable and group rated. As long as you pay the premium, you're covered. And the premium is group rated so your individual situation won't cause your rates to skyrocket.

I and my wife have had HSA plans through the Federal Marketplace that have been cancelled - or at least the plan was no longer offered so we were forced to purchase new plans. Maybe the rule you're referring to is specific to your state?

 

[daylatedollarshort]

The Kaiser Foundation has a good article on what kinds of conditions were deemed pre-existing conditions and what we might go back to if all or key parts of the ACA are invalidated:

"The impending decision by the Fifth Circuit Court of Appeals in the Texas v. Azar case raises the prospect that insurers will once again be able to return to using people’s health status in determining their eligibility and premiums for health insurance, at least for coverage obtained from the non-group, or individual insurance, market. In the case, the plaintiff states’ Attorneys General and the Trump Administration are arguing that the Affordable Care Act is unconstitutionally structured and should be invalidated in its entirety. This would include overturning provisions that guarantee that people with pre-existing health conditions cannot be denied coverage or charged higher premiums due to their health status....we estimate that 27% of nonelderly adults have a declinable health condition, which is about 53.8 million people in 2018. We further estimate that 45% of nonelderly families have at least one nonelderly adult member with a declinable health condition. ....People with pre-existing health conditions were often denied coverage or charged higher premiums for individual market coverage before the ACA took effect in 2014."

https://www.kff.org/health-reform/i...tion-prevalence-for-individuals-and-families/

 

[GenXguy]

From Politico: "SUPREME COURT WANTS TRUMP's DOJ, RED STATES TO WEIGH IN ON ACA LAWSUIT REQUEST — The high court Monday afternoon asked the Trump administration and Republican-led states challenging Obamacare to quickly respond to the request from Democratic attorneys general to fast track the case, POLITICO's Susannah Luthi reports."

That's old news. There's already been a response from both. See my earlier post in this thread:

http://www.early-retirement.org/forums/f38/before-aca-what-did-retirees-do-101562-6.html#post2354629

And new news today, the insurance lobby filed a brief with the Supreme Court to take up a case and to rule to uphold the health law.

https://thehill.com/policy/healthca...ourt-to-take-obamacare-case-uphold-health-law

https://www.ahip.org/wp-content/uploads/19-840_19-841_AHIP.pdf

 

[explanade]

Before the ACA, there were a lot of stories about rescission.

Insurers collected your premium payments for years.

When some people tried to use their coverage, they discovered that the insurers find you had a pre-existing condition that you didn't disclose, so therefore, no coverage.

 

[johnhkc]

I and my wife have had HSA plans through the Federal Marketplace that have been cancelled - or at least the plan was no longer offered so we were forced to purchase new plans. Maybe the rule you're referring to is specific to your state?

All of my research was before ACA so I don't know about the "new" ACA-compliant HSAs. Isn't "federal marketplace" an ACA thing?

I do know that in KC, Blue Cross Blue Shield was a big proponent of ObamaCare and when it was passed, they ended their old plans to push people onto ACA plans. The new premiums were typically around 125% to 150% higher in the first year than what existed before. These were small group/small employer plans. ACA did not FORCE them to terminate these plans - the company chose to. (I worked a short contract there - I saw some interesting stuff.)

Also in that year, people who had Golden Rule (UHC) plans called the company so many times that Golden Rule sent out a letter stating that they had no plans to cancel their grandfathered plans. I still have their PPO plan.

Maybe Missouri has some tight grip on insurance regulation but if they do that's about the only thing they have a tight grip on! Everything else here seems very laid back and loosey-goosey.

 

[explanade]

ACA raised requirements for what must be covered and eliminated things like lifetime caps and of course didn't allow insurance companies to exclude pre-existing conditions.

These requirements of course made coverage more expensive.

Now some are arguing that insurance policies which aren't comprehensive should be sold as well.

I believe they have been selling such policies the last couple of years but no word on how many enrollments they've gotten.

 

[Mulligan]

All of my research was before ACA so I don't know about the "new" ACA-compliant HSAs. Isn't "federal marketplace" an ACA thing?



I do know that in KC, Blue Cross Blue Shield was a big proponent of ObamaCare and when it was passed, they ended their old plans to push people onto ACA plans. The new premiums were typically around 125% to 150% higher in the first year than what existed before. These were small group/small employer plans. ACA did not FORCE them to terminate these plans - the company chose to. (I worked a short contract there - I saw some interesting stuff.)



Also in that year, people who had Golden Rule (UHC) plans called the company so many times that Golden Rule sent out a letter stating that they had no plans to cancel their grandfathered plans. I still have their PPO plan.



Maybe Missouri has some tight grip on insurance regulation but if they do that's about the only thing they have a tight grip on! Everything else here seems very laid back and loosey-goosey.

I dont know anything about this. What I do know is I live in MO and had a pre ACA plan that was an HSA. It lasted for 3 years into ACA then it got dropped by insurer and off to ACA I went. I have an HSA plan now but it is through ACA .

 

[Offgrid Organic Farmer]

I dont know anything about this. What I do know is I live in MO and had a pre ACA plan that was an HSA. It lasted for 3 years into ACA then it got dropped by insurer and off to ACA I went. I have an HSA plan now but it is through ACA .

My current HealthCare coverage pre-dates ACA, and it is still going.

 

[mpeirce]

I dont know anything about this. What I do know is I live in MO and had a pre ACA plan that was an HSA. It lasted for 3 years into ACA then it got dropped by insurer and off to ACA I went. I have an HSA plan now but it is through ACA .

I’m still in a preACA HDHP/HSA here in Ohio (Anthem).

 

[harley]

My current HealthCare coverage pre-dates ACA, and it is still going.

Didn't you say you're covered through the military? Of course it would still be available, and will probably be whether the ACA survives or not. I think the topic has to do with people needing to get insurance on their own before the ACA, and possibly after depending on it's future.

I've got coverage through my previous employer, but had to remain employed past FI in order to qualify. They can do away with it at any time, which has been a significant worry for the past 13 years or so. I finally will reach Medicare age later this year, so that worry will go away. When I reached FI I looked into getting a (pre-ACA) policy for DW and I, but due to pre-exising conditions I couldn't find one, affordable or not. So I worked for a couple more years until I qualified through work.

I'm not a big fan of the Medicare for all concept, mostly for economic and basic distrust of government reasons, but I do empathize with those who are in the same boat of unsuredness. I hope we don't ever return to the days of pre-existing conditions stopping people from being able to find any coverage.

 

[pb4uski]

Not true--not everyone could buy insurance before the ACA. Pre ACA my DH had a preexisting condition and no private health insurance company in our state would issue a health insurance plan to him at any cost. He was without health insurance for a while and was thinking of going back to work just to get the insurance. Finally our state started a high risk pool and he was able to get on it but the premium was about $1000 per month and the coverage was very limited (no drug coverage) and the policy had a lifetime cap of $1,000,000. Pre ACA health insurance was practically nonexistent for early retirees with preexisting conditions in many states.

It depended on where you live. Vermont banned medical underwriting in 1992.

 

[ERhoosier]

pb4uski is right. It certainly depended on where you lived. Pre-ACA some states were much more favorable for HI than others, and many ERs relocated for that reason. Medical refugees, so to speak.

 

[GenXguy]

That's old news. There's already been a response from both. See my earlier post in this thread:

http://www.early-retirement.org/forums/f38/before-aca-what-did-retirees-do-101562-6.html#post2354629

And new news today, the insurance lobby filed a brief with the Supreme Court to take up a case and to rule to uphold the health law.

https://thehill.com/policy/healthca...ourt-to-take-obamacare-case-uphold-health-law

https://www.ahip.org/wp-content/uploads/19-840_19-841_AHIP.pdf

Update from yesterday:

The Supreme Court will not be expediting this case, so it looks like this will drag out for well over a year.

https://www.cnn.com/2020/01/21/politics/supreme-court-obamacare-challenge-denial/index.html

 

[Dtail]

Update from yesterday:

The Supreme Court will not be expediting this case, so it looks like this will drag out for well over a year.

https://www.cnn.com/2020/01/21/politics/supreme-court-obamacare-challenge-denial/index.html

Well it looks like the ACA now survives at least through 2021. I need it for 3 years after that.

 

[GenXguy]

It looks like there's still a possibility of the Supreme Court taking up the case this term, after-all. I wouldn't bet on it, though.

https://thehill.com/policy/healthca...er-taking-obamacare-case-at-feb-21-conference

The Supreme Court on Wednesday listed a closely watched case seeking to strike down the Affordable Care Act for discussion at the justices’ private conference on Feb. 21.

The justices will consider whether to take up the case and on what schedule.

There is at least some possibility they could decide to take the case this term, meaning a ruling would be issued by June. But most observers expect a ruling will not come until after the 2020 election, either because the court waits until the next term to hear it, or because it decides not to take up the case at all until lower courts have finished considering it.

 

[pb4uski]

The Administration had previously requested SCOTUS to slow-track reviewing the case.... from Jan 10, 2020 article:

The Trump administration on Friday said it would be premature if the Supreme Court decided to expedite a review of a lawsuit seeking to overturn ObamaCare. ...

Seems like they want it... but just not in an election year when people might be paying attention.