Nice summary from Ways and Means on proposed changes to ACA released today...

[kcowan]

Most purchase travel health insurance for their time in FL, and as I understand it, emergencies are covered, but non life threatening issues have to be dealt with in Canada.

There are all types of policies, including just air vac, all the way to hospital admission. They all reserve the right to fly you home if that is feasible and cheaper.

 

[GTFan]

Let's be precise and accurate, because this is a complicated subject that deserves it. The new plan changes the allowable difference in premiums between what young people pay and what older people pay. It was a 1:3 ratio, it will now be 1:5. Nobody knows if the actual premiums, in dollars, paid by old people will be higher.

Lets actually be more precise and accurate - the new 5:1 ratio is ONLY if states don't do their own regulations that make it whatever they want. And so there could very well be no cap in some states.

 

[pb4uski]

Well, I can go to sleep tonight feeling happy and thankful that our wonderful leaders in Congress won't have to use whatever health care plan they enact.

Actually, you are succumbing to an urban myth.... they currently use ACA marketplace plans.

Sen. Ted Cruz says Obama 'just granted all of Congress an exception' to Obamacare | PolitiFact

"When Obamacare’s health care marketplaces launch in January 2014, members of Congress will use them right alongside the uninsured.

Here's what the law said:

"Notwithstanding any other provision of law … the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are — (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act)."

All it did was require lawmakers to use new marketplaces. They're doing that"

----------------------------------------
https://www.washingtonpost.com/poli...7d70d0-5de7-11e3-bc56-c6ca94801fac_story.html

"For years, members of the House and Senate and tens of thousands of congressional staffers have enrolled in the Federal Employee Health Benefits Program, the same health insurance program available to millions of active and retired federal employees. As members of the *FEHBP, lawmakers and staffers received a taxpayer-funded employer contribution to help defray the cost of their premiums.

Changes enacted as part of the ACA require lawmakers and most congressional staffers to join the D.C. exchange to continue receiving the employer contribution."

 

[Fermion]

Lets actually be more precise and accurate - the new 5:1 ratio is ONLY if states don't do their own regulations that make it whatever they want. And so there could very well be no cap in some states.

Well that is DOA then. What good is insurance availability if the premium is $200,000 a year?

 

[pb4uski]

You're being silly... even if there was no cap supply and demand and competition will force a cap at essentially cost + overhead and profit... if a carrier tries to get pig-headed then it will be attractive for other carriers to step in and compete.... also, there is that pesky MLR rule.

 

[GTFan]

There's no need to ban employer-provided coverage.

Agreed as long as they remove the tax bennies for employer and employee, which is a political non-starter.

 

[Fedup]

The reason our employer-based insurance and Medicare work so well is because people can't really opt out of them. I have to buy the plan that my employer offers. Likewise, Medicare is so heavily subsidized that even a perfectly healthy senior is going to sign up.

With individual plans, the healthy people are very likely to drop a plan as it becomes expensive. So it death spirals naturally, unless you have all the underwriting, segmentation, etc. The ACA has the individual mandate and the limited enrollment period (and subsidies for lower incomes) to try to force healthy people into the pool. However, it is not clear that those were going to be enough long term. Insurance companies has recommended tighter controls to the exceptions to the enrollment period and a larger individual mandate penalty. I think those fixes make sense.

Since this new plan has reduced subsidies and what appears to be a weaker penalty for going without insurance for healthy people, I expect it to death spiral quickly.

Not always. I covered my husband and kids under my plan when I was working at a MegaCorp. He opted out of his employer's plan because it's not as good. Plus when I pay for family, whtwger its 3 or 4, it's the same.

 

[GTFan]

Some are not heavily subsidized, but from what I hear no Credits for anyone who could use an employer plan.

Is that true, no credits for retiree insurance? Bummer for me in that case, I'm betting under the new rules that my unsubsidized Megacorp plan will be cheaper than open market. But without tax credits I would likely be forced to go open market, just like today.

 

[Hamlet]

You're being silly... even if there was no cap supply and demand and competition will force a cap at essentially cost + overhead and profit... if a carrier tries to get pig-headed then it will be attractive for other carriers to step in and compete.... also, there is that pesky MLR rule.

I believe that this bill gets rid of the medical loss ratio requirements as well as the minimum actuarial requirements.

 

[GTFan]

And HI from your company is a BENEFIT, not compensation. Why all the trying to tax and redistribute so that ANOTHER person can benefit with lower HI premium and RE? Just plan accordingly, it doesn't have to be someone else's job to help with another ability to ER.

We're already redistributing the taxes here because those BENEFITS are tax-free. Both employer and individual markets are subsidized today.

 

[Fermion]

You're being silly... even if there was no cap supply and demand and competition will force a cap at essentially cost + overhead and profit... if a carrier tries to get pig-headed then it will be attractive for other carriers to step in and compete.... also, there is that pesky MLR rule.

Because we have never seen an entity try and make a gross profit in a cornered market, right? Right Mr. Shkreli?

 

[GTFan]

I believe that this bill gets rid of the medical loss ratio requirements as well as the minimum actuarial requirements.

Don't see anything in the new bill summaries that repeals MLR, so apparently the 80% rule stays in effect.

 

[MRG]

For any new health care proposal, I would like it to begin with "here is how we are going to reduce health care costs in the US from $10K/capita to ~$5K/capita, like the rest of the first world." And show your work.

Oh there you go with common sense. That's not going to fly.

 

[Winemaker]

And HI from your company is a BENEFIT, not compensation. Why all the trying to tax and redistribute so that ANOTHER person can benefit with lower HI premium and RE? Just plan accordingly, it doesn't have to be someone else's job to help with another ability to ER.

Taxation of Healthcare benefits was part of ACA, it has just been delayed several times. It was considered one of the parts of the law that Prez Obama changed after it's passage.

It is also part of the new proposal.

Also:
http://www.zerohedge.com/sites/default/files/images/user3303/imageroot/2017/03/09/20170310_obo.jpg

 

[fh2000]

"SECTION_15: REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE
This section creates an advanceable, refundable tax credit for the purchase of state-approved, major
medical health insurance and unsubsidized COBRA coverage. To be eligible, generally, an individual
must not have access to government health insurance programs or an offer from any employer and be
a citizen, national or qualified alien of the United States, and not incarcerated. The credits are adjusted
by age:
• Under age 30: $2,000
• Between 30 and 39: $2,500
• Between 40 and 49: $3,000
• Between 50 and 59: $3,500
• Over age 60: $4,000"

I assume the unsubsidized COBRA is the full price group insurance for ex-employees. The cheapest option our Megacorp offers, costs about $24,000 a year for family. A family of 4 could qualify for $11,500 tax credit. The actual monthly premium less credit will be about $1042.

 

[jetpack]

Disappointingly I don't read anything that fundamentally will reduce the cost of health care.

Indeed. This is what I was looking for in both Obamacare and this. Haven't seen anything that would actually help reduce the cost. This needs to be addressed.

 

[scrabbler1]

Wouldn't having more people with insurance and able to visit their doctors in their offices for their primary care instead of going the far costlier emergency rooms be an overall cost reduction to the health care delivery system?

 

[MRG]

Indeed. This is what I was looking for in both Obamacare and this. Haven't seen anything that would actually help reduce the cost. This needs to be addressed.

Prior to the election there was information on a candidate's website. It's been gone since the election.

I don't understand how we can allow the cost of Healthcare to run unchecked. I sure don't think anything I've heard or read addresses how to solve the core issues. IMHO the various experts they appear like blind people examining an elephant.

 

[samclem]

Agreed as long as they remove the tax bennies for employer and employee, which is a political non-starter.

Let's see about that. The present size of our government fisc is ample testimony to the legislature's time-proven ability to pass new tax laws.

 

[samclem]

Indeed. This is what I was looking for in both Obamacare and this. Haven't seen anything that would actually help reduce the cost. This needs to be addressed.

It does need to be addressed, but it can't go in this bill (if this bill is to be passed under the rules of reconciliation). Those parts are promised in the coming legislation.

 

[Fedup]

My take on this is a repeal Obamacare bill and some replacement. Older folks will pay more than young kids. But hopefully, the premium for younger kids will go down and the 5:1 ratio won't make the older people's bill not go up too much. It also a bill to peel slowly off entitlement. Some people will not like it, especially when they get a lot of subsidy, especially for people living in HCOL area. Because the subsidy of Obamacare takes into account of that.

 

[TreeHugger]

It does need to be addressed, but it can't go in this bill (if this bill is to be passed under the rules of reconciliation). Those parts are promised in the coming legislation.

Reconciliation can only be used for provisions that have a significant inpact on the federal budget. Such as reducing taxes of some people and eliminating subsidies for others.

Anything else will have to go through traditional legislative process, which means they will require 60 votes to pass the Senate. Take a wild gues how it will go

 

[pb4uski]

Because we have never seen an entity try and make a gross profit in a cornered market, right? Right Mr. Shkreli?

Health insurance is hardly a cornered market.

 

[pb4uski]

"SECTION_15: REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE
This section creates an advanceable, refundable tax credit for the purchase of state-approved, major
medical health insurance and unsubsidized COBRA coverage. To be eligible, generally, an individual
must not have access to government health insurance programs or an offer from any employer and be
a citizen, national or qualified alien of the United States, and not incarcerated. The credits are adjusted
by age:
• Under age 30: $2,000
• Between 30 and 39: $2,500
• Between 40 and 49: $3,000
• Between 50 and 59: $3,500
• Over age 60: $4,000"

I assume the unsubsidized COBRA is the full price group insurance for ex-employees. The cheapest option our Megacorp offers, costs about $24,000 a year for family. A family of 4 could qualify for $11,500 tax credit. The actual monthly premium less credit will be about $1042.

Just thinking... if premiums can be up to 5:1, shouldn't credits be 5:1 as well to be "fair".

 

[Meadbh]

I don't understand how we can allow the cost of Healthcare to run unchecked. I sure don't think anything I've heard or read addresses how to solve the core issues. IMHO the various experts they appear like blind people examining an elephant.

President Obama chose Dr. Don Berwick to run Medicare, but his nomination was rejected because Congress felt he was "too socialist". Dr. Berwick has been for several decades the preeminent leader in healthcare quality improvement in the US and internationally. Had his apppointment gone through, healthcare in the US might be much more patient centred and efficient today. This was a gigantic missed opportunity IMHO.