Curious what others think will happen if ACA is overturned by SCOTUS

[Bamaman]

Health insurance--cannot live without it and few can afford co-pays and deductibles of the ACA.

Sure some citizens are on ACA. But the vast majority of those slated to go on the ACA cannot afford the program and remain like they were before the ACA--uninsured.

And the uninsured still obtain healthcare at the same hospitals we go to. Difference is I have to pay $300 co-pay when I walk into the hospital. The truly uninsured walk out the door without paying anything.

They continue to use our emergency room as their doctor's office for minor health issues instead of having a personal physician--just like pre-ACA.

There is a solution to the healthcare problem in the U.S.A. And there are many healthcare professionals that have a plan of action. But politicians have the ultimate say-so and they're not willing to make the needed changes in the system. The ACA is simply not the fix.

 

[LARS]

Riddle me this one.

Say ACA IS struck down in 2021, hypothetically say in June 2021. It still would be available in the November / December 2020 signup for 2021, and would become active in January 2021.

If struck down, would ACA contracts for 2021 become void and folks left without Healthcare insurance?

Answering my own question, somehow I doubt it.

Yeah, I posed this same question earlier in the thread. And I came to the same conclusion as you. At least for the year in which the SCOTUS decision is made, assuming negative, I presume health insurance companies will have to honor the full year.

 

[GTFan]

Health insurance--cannot live without it and few can afford co-pays and deductibles of the ACA.

Sure some citizens are on ACA. But the vast majority of those slated to go on the ACA cannot afford the program and remain like they were before the ACA--uninsured.

This is untrue, the vast majority of those eligible for the ACA get subsidies. It is a terrible law for those over the cliff and it must change for those.

https://www.kff.org/other/state-ind...0&sortModel={"colId":"Location","sort":"asc"}

 

[ShokWaveRider]

This is untrue, the vast majority of those eligible for the ACA get subsidies. It is a terrible law for those over the cliff and it must change for those.

https://www.kff.org/other/state-ind...0&sortModel={"colId":"Location","sort":"asc"}

Hardly a terrible law for those folk as one would argue the over the cliff folks can afford it. Certainly not for those who get subsidies. That is how insurance works, spreading the load / risk.

BUT, If it went away nothing would really change for the over the cliff folks, well premiums would probably go up for them, as the money that was going to the insurance companies as subsidies would go away, a lot of folks would not be able to afford insurance and then would use emergency rooms etc., at someone's cost. It would be a cascading effect.

Simply striking down the ACA after 10 years without a comparable / viable alternative, now that would be terrible. I think the supreme court understands that.

 

[UnrealizedPotential]

Bamaman raised an interesting point. The politicians have the power to fix healthcare but refuse to do so. I know why and think others know too why nothing gets done regarding healthcare. I don't want to end up on the bad side of the moderators so I will stop short of going further, but it is frustrating to watch year after year.

 

[GTFan]

Hardly a terrible law for those folk as one would argue the over the cliff folks can afford it. Certainly not for those who get subsidies. That is how insurance works, spreading the load / risk.

Tell that to the couple who make just over $64k in a HCOL area looking at $1500+ monthly premiums WITH high deductibles. This is unaffordable and not uncommon. If you haven't seen these stories or posts here you're just not looking hard.

It is a terrible law for many over the cliff. We just happen to be the lucky ones that can game the system to get decent insurance for cheap.

 

[ShokWaveRider]

Tell that to the couple who make just over $64k in a HCOL area looking at $1500-2000 monthly premiums WITH high deductibles. This is not uncommon.

It is a terrible law for many just over the cliff. We just happen to be the lucky ones that can game the system to get decent insurance for cheap.

I do not want to argue with you, but what makes you think it would be better with no Healthcare Laws at all? It would probably be worse, and woe betide if one of the family has a pre-existing condition.

Agreed that it needs to be expanded to help those say up to $128k family income as opposed to $64k., which is low in this day and age. Then those over $128k will probably moan then. But unfortunately that does not seem to be in the cards, it is all or nothing at the moment. So it is better to have something than nothing at all, at least IMHO.

 

[GTFan]

There is a solution to the healthcare problem in the U.S.A.

Which is?

 

[scrabbler1]

As someone who has bought HI before and after the ACA, I can tell you that pre-ACA was awful. After a 50% increase from 2009 to 2011, I was paying in 2011 what I would be paying in 2020 (without any subsidy). I can't begin to imagine what I would be paying this year without the ACA, even with modest increases in the 9 years.


That being said, the cliff nature of the ACA subsidies is lousy. Simply phasing out the subsidies gradually the way other credits within the tax code are done today would be much fairer and would undoubtedly lead to less gaming of the system and not overly penalize those of us (like me, in 2017 through 2019) who did not go over the limit by much.


Still, the flawed ACA with its cliff subsidies is better than no ACA at all.

 

[GTFan]

I do not want to argue with you, but what makes you think it would be better with no Healthcare Laws at all? It would probably be worse, and woe betide if one of the family has a pre-existing condition.

Nice strawman, I never said there shouldn't be a HC law. All I said is that the ACA is flawed and changes must be made.

 

[ShokWaveRider]

Nice strawman, I never said there shouldn't be a HC law. All I said is that the ACA is flawed and changes must be made.

OK, but the OP was asking about the current situation if it was struck down, not about the ACA itself. I was trying to stay on point.

 

[Montecfo]

I also doubt it will be struck down.

You already had coverage for pre-existing conditions under HIPPA before ACA. You just have to maintain coverage. Can't drop coverage and wait till you get sick.

Overall you would have more policy choices, and some cheaper options. There would be more of a push to make pricing more transparent, and increase competition.

Policies in place would I'm sure remain in place. Supremes can make their ruling effective in the future.

 

[rrppve]

As others have said, it will be up to the States. Fortunately, I live in California, which will maintain some form of it.
If you have maintained continuous insurance, I believe you will be able to get new insurance without medical underwriting at a standard rate.
The real issue will be those on subsidy, as they need some sort of government supported health insurance. Elections exist for a purpose, and you can be sure that if ACA is struck down, it will be a huge campaign issue in November.
I personally have a different issue with the ACA. It outlawed true catastrophe insurance. I’d rather pay a much lower premium, but have a high deductible of $50k or more. Pay for all my standard medical care at reduced cash prices myself. Unfortunately, this type of insurance plan is illegal under ACA.

 

[pb4uski]

Led by Roberts who stretched to uphold in 2012, he's not going to reverse course.

Doesn't really matter to me because the guaranteed issue ship has sailed, there will be legislation requiring insurers to cover all comers no matter what happens to the ACA. We're way past that being an issue now.

The timing of all this with COVID going on boggles the mind, frankly. This will be hammered repeatedly even more than it was in 2018.

I think we'll see something in between, like no medical understanding if you have had continuous coverage for the last 24 or 36 months, but if you don't have continuous coverage you need to wait until the next open enrollment. There needs to be something to prevent people from just signing up once they are sick.

 

[scottpush]

I have no idea what will happen but have always thought it was too good to be true and would disappear someday.

Will then pay for my own healthcare/insurance.

I retired at 58 and on ACA. I have had HBP for 15 years and therefore don't qualify for anything except government insurance or job insurance, of course. I suppose MD would pick up the slack with Medicaid Expansion if it were overturned but hopefully it will hang in there. If I lived in Florida I'd be screwed, they don't have Medicaid expansion.

 

[scottpush]

It seems to me that it's an all or nothing situation. They either get rid of the ACA completely or not at all. I think not at all. For my personal situation, I hope it stays in place. If it is abolished I would have to go on Medicaid I guess. My income is $15-20K/yr or less if I choose as I am self employed part time. I have chronic pain that leaves me unable to do full time work yet am not disabled enough to get SS disability because I am only 40(41 in August). It would be very bad for me and millions of other lower income/net worth people if it was abolished.

You must be one of the lucky ones who live in a state that has Medicaid Expansion. I think about 13 states don't and I don't believe you could get insurance there at all if ACA didn't exist. Whew!

 

[Toocold]

If it gets overturned, it would then turn to the state to regulate as always, without the subsidies and medicaid expansion.

I use my state run insurance exchange without subsidies, so no change for me.

This is untrue, the vast majority of those eligible for the ACA get subsidies. It is a terrible law for those over the cliff and it must change for those. https://www.kff.org/other/state-indi...2:"asc"}

Wow, I need to figure out how to lower my MAGI.

 

[GTFan]

Yep, keeping MAGI low allows us to get a great Silver CSR plan for cheap. The only real issues are the narrow networks and lack of national coverage other than emergencies, but that's par for the course for just about all ACA plans.

 

[Hyper]

No desire to look for the article but a cpl yrs back I was trying to understand the subsidies of ACA for those with NW and came across an article that stated, if they were to deny HI w/subsidies to those with a NW, they would have to tax all those getting HI from their employer. Through DW, HI premiums are $6k ish. If we were on ACA without subsidies HI Premiums would be $36k ish. Still get confused when I think about it too much!

 

[cathy63]

No desire to look for the article but a cpl yrs back I was trying to understand the subsidies of ACA for those with NW and came across an article that stated, if they were to deny HI w/subsidies to those with a NW, they would have to tax all those getting HI from their employer. Through DW, HI premiums are $6k ish. If we were on ACA without subsidies HI Premiums would be $36k ish. Still get confused when I think about it too much!

Your DW's premiums are probably higher than $6K. That's the part she has withdrawn from her check and pays out of untaxed money. Her employer probably also pays part of her premium and she doesn't pay tax on that benefit either.

One of the suggestions that's been floated in the past to equalize things is that people who buy insurance on the open market should also be able to purchase it with tax free money, or alternatively, that those who get employer sponsored insurance should pay income tax on the entire premium amount. If this happened, it would change the subsidy calculation, but they wouldn't disappear.

 

[Mr._Graybeard]

In my state, utilities are regulated by a public service commission. It's often a rubber stamp for rate increases and infrastructure projects, but at least they get a review, and hearings give the public a chance to weigh in on proposed changes.

Hospitals are also part of the public infrastructure, IMO. Sooner or later, 99% of the population are in one. If I were omniponent, I would reclassify hospitals as utilities and hand over their regulation to state panels in the same way other utilities are regulated. The providers would probably get their way most of the time but at least someone would be reviewing their operations.

 

[MichealKnight]

My uneducated guess....

ACA survives. From what I've read - even some Conservative legal minds feel this is a weak challenge. Also, Justice Roberts once helped keep ACA alive....and he seems to like not being a 'sure' thing on anything. If I were placing a bet in Vegas - I'd make a small bet that ACA survives Scotus.

 

[Dtail]

Yep, keeping MAGI low allows us to get a great Silver CSR plan for cheap. The only real issues are the narrow networks and lack of national coverage other than emergencies, but that's par for the course for just about all ACA plans.

If you move one state down, in general you will have great rates and a wide network.
National coverage - no.

 

[EdL3]

Continue paying $945 per month through my retiree medical plan with a $4,500 deductible for 5 years until I am eligible for Medicare.

 

[Poopycat]

For me, this is such a scary decision. Yes, currently it could be a 5-4 decision, but we are banking on the continued health of Ruth Bader Ginsburg for another year.

While I’m hoping that the ACA is upheld, some states will continue to uphold nondiscrimination for pre-existing conditions and guaranteed issue. Many states have already passed laws to create protections of varying degrees. The degree of protection varies; AZ, for example, just says that insurers must offer insurance to those with pre-existing conditions but does not address whether there is a cap on how much extra people with pre-existing conditions could be asked to pay. Other states, like Washington and New Mexico, have passed laws that pretty much mimic ACA protections.

I imagine that other states will be forced to rush to put together some laws regarding pre-existing conditions should the ACA be struck down. I suspect that some states will reach an impasse and simply fail to put together laws that adequately protect those who have pre-existing conditions or who have lost their insurance.

But even for the states that have been progressive with respect to expanding health care coverage and insurance options, it will not be smooth sailing if ACA is struck down. Because where will the subsidy money go? I can’t imagine that the government would still pay subsidies for a law that no longer exists. And how will states that expanded Medicaid be able to sustain those programs? Won’t the money the states receive go away? The retirees and near-retirees on this board will probably be fine if they we had to pay full-fare insurance. But many others who lose their subsidies, or maybe even lose their Medicaid, may end up in a terrible situation if the ACA is repealed.

It’s going to be an interesting year in health care case law...