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

[bamsphd]

Under the current proposal there is no underwriting, just a penalty for a gap in coverage. Stay tuned for updates.

Correction/Update according to Kaiser Family Foundation Compare Proposal page, the March 6th, 2017 proposal contains exceptions for Short-term non-renewable polices:

Short-term non-renewable policies can continue to be sold using medical underwriting.

Short-term non-renewable policies can continue to set premiums based on health status.

Short term non-renewable policies can continue to exclude pre-existing conditions

However regular policies are still guaranteed issue, still cover pre-existing conditions, and can only base premiums on age (and gap in coverage).

 

[MichaelB]

Correction/Update according to Kaiser Family Foundation Compare Proposal page, the March 6th, 2017 proposal contains exceptions for Short-term non-renewable polices:

However regular policies are still guaranteed issue, still cover pre-existing conditions, and can only base premiums on age (and gap in coverage).

Isn't this the case today - short term policies are not ACA compliant and can exclude pre-existing conditions?

 

[Fedup]

This hit the nail on the head.

Any attempts to legislate costs is ludicrous. To control costs, we would have to limit services and reward/punish behavior, all of which I find unacceptable.

Currently, the plan is to pay doctors as a result of patient's improved health performance, which to some sounds pretty good. But is the same reason why doctors are dropping patients.

Some feel that those using tobacco products, drinking alcohol, owning firearms, eating sugar/high fructose corn syrup, eating animal protein, consuming farm raised seafood, GMO's, non-organic produce, caffeine, transfats, lard, baby formula and the latest poison, should be charged more for insurance. These currently legal products, but are just the refuted killer du jour.

Yeah, we beat down big pharma for their big profits in one thread, but in the other thread, we recommend this and that pharma for it's qualified dividend, bash whatever biotech buyout that creates LTCG, and allows for our 4% SWR.

Nothing passed by past, present or future legislatures is going to make everyone on this forum, or in the USA happy. Thanks to all for my vent.

Control cost is a combined effort between patient, doctor and pharma. It's not just doctors or pharmacy.
For example, in my family, the one who is a big consumer of health care is my sister. She never ever tried to exercise. Never lifted a finger to do anything. Even eat the wrong food, that's why she had pre-cancerous polyps, she admitted herself, and consumed lots of alcohol, often bragged that she could out drink many of her male friends. Last attempt I've heard was getting to the doctor late and the doctor was mad at her and now she wanted me to help her find a new doctor. I told her my doctor would kick her out if she is 5 minutes late. Because I would complain if he is 5 minutes late. Just one example of people I know. How many people like her out there? Who knows?

 

[gerntz]

The costs of healthcare in Canada are subsidized by higher prices on other goods. For example, some snowbird friends of ours from Canada pay $40.00 for a cheapo bottle of wine that sells less than $10.00 here.

That would cut my consumption by about 25 gallons/yr - putting a couple of vineyards out of business.

 

[simple girl]

First to clarify, by off-exchange ACA plan I mean a plan not purchased through the exchange which meets all the ACA requirements but was not eligible for premium subsidies.

At least in my state, most of the insurers with exchange policies also offer off-exchange policies. Some offer essentially the exact same policies at the exact same price, others offer more expensive off-exchange policies with better health networks and/or better telephone support. In my state, I did not find any companies offering off-exchange individual policies who did not also offer on-exchange policies. Your state might be different.

While I did some Google searching and found online brokers listing policies, I had the best results simply visiting the websites for each company with an exchange policy.

Great, had no clue about this. Thanks so much for the information!

 

[simple girl]

No cost analysis has been released at this time (I don't think one's been done yet from what I've read).

From the articles I have read no report has been made by the CBO yet.

 

[Cobra9777]

... Does anyone know what additional things the HSA can be used to pay for?

I've read over the counter stuff, even like band aids, I hope.

Paul Ryan has stated in the past, they wanted to open up HSAs to also include premiums and payment for other peoples health care, such as your parents ...

I like the higher HSA contribution limits. Can't beat the triple tax advantage of HSAs. I'll definitely take advantage of that if this provision of the bill passes. I'm beginning to worry though because my HSA account balance is already more than 3X the pile of medical receipts I've accumulated. That gap is now likely to grow even faster. I'm not sure band-aids are going to help much. But if I could include premiums, that would be a significant positive change.

 

[travelover]

........ I'm beginning to worry though because my HSA account balance is already more than 3X the pile of medical receipts I've accumulated. That gap is now likely to grow even faster. I'm not sure band-aids are going to help much. But if I could include premiums, that would be a significant positive change.

You can use the HSA for Medicare premiums, eye care and dental. Take up hockey, that will kick up the dental portion, for sure.

 

[simple girl]

I'm beginning to worry though because my HSA account balance is already more than 3X the pile of medical receipts I've accumulated. That gap is now likely to grow even faster.

That's a good problem to have.

 

[audreyh1]

The language on risk pools made me sit up and take notice too. Very mysterious!!!

 

[explanade]

The costs of healthcare in Canada are subsidized by higher prices on other goods. For example, some snowbird friends of ours from Canada pay $40.00 for a cheapo bottle of wine that sells less than $10.00 here.

But are those taxes only used to pay for health care or other things?

Is it only on import items?

Imported wine might be hit by low Canadian dollar?

 

[zedd]

I like the higher HSA contribution limits. Can't beat the triple tax advantage of HSAs. I'll definitely take advantage of that if this provision of the bill passes. I'm beginning to worry though because my HSA account balance is already more than 3X the pile of medical receipts I've accumulated. That gap is now likely to grow even faster. I'm not sure band-aids are going to help much. But if I could include premiums, that would be a significant positive change.

Interesting. The proposed bill revises the income test of refundable tax credit eligibility for health insurance :

SECTION_15: REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE

... The credits are available in full to those making $75,000 per year ($150,000 joint filers). The credit phases out by $100 for every $1,000 in income higher than those thresholds.
...

As stated by others before, this change makes ROTH conversions more attractive.

Combine the income test revision with higher HSA limits and potentially allow premium payments from HSAs; that would be helpful.

Oh shoot I'll just propose what I want: allow tax-free distributions (rollovers?) from IRAs into HSAs (with correspondingly higher limits) and then allow health care premium payments from HSAs. Rinse, repeat.

Just bracing myself for higher real health care premiums. Finding the money to pay for premiums out of my tax-deferred accounts admittedly doesn't change my SWR, but my proposal wont raise my taxable income either.

 

[laurence]

Why does this make Roth conversions more attractive? Is it just that you have more room to do so below the ceiling?

My takeaway is that DW and I should make sure our retirement income stays under $150k taxable in retirement - I'm sure someone has done the math on how this effects paid off mortgage/lower income vs. higher returns from market/shaving the $8k tax benefit down....

 

[zedd]

Why does this make Roth conversions more attractive? Is it just that you have more room to do so below the ceiling?

.

Bingo. But more specifically generally Roth conversions up to the 15% bracket are favorable. The current ACA income test significantly lowered that ceiling.

 

[Big_Hitter]

This summary is pretty thorough.

http://files.kff.org/attachment/Pro...e-Act-Summary-of-the-American-Health-Care-Act

edit: sorry mods, saw you just posted this

 

[MichaelB]

This summary is pretty thorough.

http://files.kff.org/attachment/Pro...e-Act-Summary-of-the-American-Health-Care-Act

edit: sorry mods, saw you just posted this

Simple Girl posted it here http://www.early-retirement.org/for...o-aca-released-today-85761-4.html#post1848854

 

[Fedup]

I like the higher HSA contribution limits. Can't beat the triple tax advantage of HSAs. I'll definitely take advantage of that if this provision of the bill passes. I'm beginning to worry though because my HSA account balance is already more than 3X the pile of medical receipts I've accumulated. That gap is now likely to grow even faster. I'm not sure band-aids are going to help much. But if I could include premiums, that would be a significant positive change.

I was kidding about the band-aid part. But I wonder if you have to have a high deductible plan to contribute to HSA account.

 

[bamsphd]

Isn't this the case today - short term policies are not ACA compliant and can exclude pre-existing conditions?

Yes, but I mistakenly implied otherwise when I wrote:

Under the current proposal there is no underwriting, just a penalty for a gap in coverage. Stay tuned for updates. .

So I was just correcting the information I provided earlier to cover that edge case. (Can you detect my engineering/science background yet? )

 

[6miths]

The costs of healthcare in Canada are subsidized by higher prices on other goods. For example, some snowbird friends of ours from Canada pay $40.00 for a cheapo bottle of wine that sells less than $10.00 here.

lol. I think you are drinking the cool-aid being dispensed by those against socialized health care. I have never heard this argument before. I am not a wine drinker but when I do go to the government run liquor store to buy wine my goal is always to get out paying no more the CAD 8 a bottle which is USD 6 this week. There is a large selection at this price and no one seems to be complaining while they are drinking it. They may just be being polite but DW is the primary consumer and she isn't so afflicted when it comes to me or wine!

 

[explanade]

No domestic wines in Canada right, all imported?

 

[MichaelB]

No domestic wines in Canada right, all imported?

A few years back my SIL brought me some Canadian ice wine, so there is some domestic production.

 

[NW-Bound]

lol. I think you are drinking the cool-aid being dispensed by those against socialized health care. I have never heard this argument before. I am not a wine drinker but when I do go to the government run liquor store to buy wine my goal is always to get out paying no more the CAD 8 a bottle which is USD 6 this week. There is a large selection at this price and no one seems to be complaining while they are drinking it. They may just be being polite but DW is the primary consumer and she isn't so afflicted when it comes to me or wine!

When we visited Canada, I did not pay attention to the price of booze. On RV trips, I brought enough for the visit, and when we did fly-and-drive, I ordered at restaurants. Next time, I will look around out of curiosity.

A Canadian RV'er couple whose blog I follow refuse to buy any alcohol when they are back home, complaining that the price is too high. Perhaps it's because they are on a budget. They generally drink $200-250 worth a month when in the US or in Mexico. That's a lot of alcohol consumption compared to what I drink, so I am impressed that they can be teetotalers for a 4 or 5 month stretch.

 

[rodi]

Control cost is a combined effort between patient, doctor and pharma. It's not just doctors or pharmacy.
For example, in my family, the one who is a big consumer of health care is my sister. She never ever tried to exercise. Never lifted a finger to do anything. Even eat the wrong food, that's why she had pre-cancerous polyps, she admitted herself, and consumed lots of alcohol, often bragged that she could out drink many of her male friends. Last attempt I've heard was getting to the doctor late and the doctor was mad at her and now she wanted me to help her find a new doctor. I told her my doctor would kick her out if she is 5 minutes late. Because I would complain if he is 5 minutes late. Just one example of people I know. How many people like her out there? Who knows?

It would be nice if it were that simple. I've been on HDHP with HSA for the past 2 years. Both years I maxed out the OOP/deductible. The first year because my kids had a series of sports injuries (DS#2 broke left elbow in basketball; DS#1 broke orbital socket/face in baseball accident; DS#2 breaks other arm's wrist in baseball accident. DH gets food poisoning after visiting a place (yosemite) that has signs warning of plague - after phone consult with insurer advised to go to ER.) The second year was confined to one family member - dentist finds DS#1 has an ameloblastoma eating away at this jaw - major surgery to remove it.

We're told to eat right, exercise (including playing sports), brush our teeth, get sleep. We did all that - and the sports got us one year and random chance got us the year.

Not all medical expenses are lifestyle issues.

 

[explanade]

Hmm, this article suggests that conservative health care policies covering fewer people is not a bug but a feature, because 1) the ACA subsidies disincentivizes people to work more and earn more income and 2) it allows people to retire early, which is not a desirable outcome:

The other is that the ACA makes it easier for workers in their late 50s or early 60s to retire early, by ensuring they don’t need to maintain a full-time job to maintain their health insurance.

“Supporters of the law touted this decrease as beneficial,” he writes, since, after all, retiring early sounds nice but is “terrible news for the economy,” which will miss the workers.

http://www.vox.com/2017/3/8/14843762/ahca-republican-lies-obamacare

 

[travelover]

.............Not all medical expenses are lifestyle issues.

No, but such anecdotes make it a lot easier to be callous to the plight of the less fortunate.