Obamacare ruled Unconstitutional!!

[scrabbler1]

That’s funny and often true but in this case...the CBO has run the numbers for us.


The CBO's latest projections from earlier this year show government paying out an average of $6,300 annually for every subsidized enrollee in fiscal 2018. It estimates that number will rise to nearly $12,500 in 2028. In contrast, Medicaid spends $4,230 per non-disabled adult, set to inflate at 5.2% annually to just over $7,000 per person in 2028.

Here’s a graph for you to visualize
View attachment 30199

Your figures are on a per-person basis, while pb4uski's are on an aggregate basis. Remember that we have around 150 million people receiving their HI through employer coverage, while around 9 million have their through the ACA and around 74 million through Medicaid. I was trying to match the people counts I found with the per-person counts you posted to see if they came close to pv4uski's aggregate amounts and they came pretty close (my people counts were from 2016, so I know I was mixing some numbers which were not from the same time periods).

My point is: Is a program expensive because its per-person subsidy is high even though the number of people receiving the subsidy is way, way lower? Or is a program expensive because its total spending is high even though its per-person subsidy is much lower? I lean toward the latter.

 

[Aerides]

Assuming the ACA goes away, how would this effect Medicaid expansion in the states that have done so? I'm clueless on this but wasn't Medicaid expansion simply a by product of the ACA? Would states continue with the expansion?

No one can know for sure (and don't believe anyone who speaks definitively about what will and won't happen) but the current thinking (big IF: IF the ruling holds) is that the current ACA law is being challenged. That means the whole package of the law, not a line item in it.

The ruling implies that everything in that law: Healthcare.gov, subsidies, pre-existing, required coverage, medicaid expansion, mandate, all of it, goes poof. Even though congress has already changed the tax law (of which the ACA is already a part) to set the mandate to Zero penalty, the law still says mandate, hence here we are.

Sure, worst case scenario, I believe some states may look to consider their own versions and portions of the law, but I'm on the side of believing it won't come to that. I'm also on the side of not wanting to stress worrying about it over the next 18+ months before this even reaches scotus, if that.

 

[Smitty700]

I'm also on the side of not wanting to stress worrying about it over the next 18+ months before this even reaches scotus, if that.

+1. Aerides has a great point. Think of the timeline. The earliest SCOTUS will hear this will probably be the fall of 2019 with a decision around May of 2020. No matter what SCOTUS determines, the current rules for the ACA will be in place through 2020, maybe 2021. And that doesn't even take in account the remote possibility that our new divided congress could actually do something useful about the issue.

 

[simple girl]

+1. Aerides has a great point. Think of the timeline. The earliest SCOTUS will hear this will probably be the fall of 2019 with a decision around May of 2020. No matter what SCOTUS determines, the current rules for the ACA will be in place through 2020, maybe 2021. And that doesn't even take in account the remote possibility that our new divided congress could actually do something useful about the issue.

As someone who is getting ready to FIRE this spring, I find this somewhat comforting. Somewhat. Can't say any of this makes me feel comfortable.

Part of me thinks if the ACA did go away, what would they do with all the people on it already? I would hope there would have to be a weaning off period or some kind of grandfathering system, where if you had coverage you couldn't be booted off as long as you kept paying. This may not be the case but again that gives me a bit more comfort thinking along those lines. It also makes me think, there might be an advantage to getting on an ACA plan now, while you can.

As a last resort, if we became uninsurable again due to pre-existing conditions, one of us would have to get a job with healthcare coverage, or we'd have to move elsewhere. It's either that or hubby keeps working FT on the "maybe" chance that we'll be uninsurable sometime in the future. I so want him to be free of stress that I am willing to risk the unknown of what is going to happen with the ACA.

What are everyone else's contingency plans?

 

[Smitty700]

What are everyone else's contingency plans?

I've got 6 years to Medicare; my wife has 5. We go on an ACA plan on January 1 for the first time since my COBRA has run its course.

My view of the worst case is that ACA is declared unconstitutional by SCOTUS, throwing the ACA into chaos for 2021. Even our dysfunctional Congress will be forced to do something to avoid the pitchforks and torches, such as applying a constitutional band aid to the ACA for a year or two to buy them some time.

There will be much noise but little change for the next four years or so. Pretty much status quo.

 

[MRG]

What are everyone else's contingency plans?

I'm 3 year 4 months away from Medicare. When I retired the first year there was no ACA implementation yet.

I talked with a broker who a bunch of Megacorp people used. She would put together a combination of plans. Mainly catastrophic coverage. It wasn't very great nor did you get coverage for some conditions. That's plan B.

 

[easysurfer]

+1. Aerides has a great point. Think of the timeline. The earliest SCOTUS will hear this will probably be the fall of 2019 with a decision around May of 2020. No matter what SCOTUS determines, the current rules for the ACA will be in place through 2020, maybe 2021. And that doesn't even take in account the remote possibility that our new divided congress could actually do something useful about the issue.

I've learned that with respect to the ACA, better being reactive than proactive as the ACA is a [-]political football[/-] tug of war. Trying to be proactive and plan ahead, at least in the current state, will just lead to whiplash .

 

[Dtail]

What are everyone else's contingency plans?

I figure we are safe through 2020. In 2021, I will be 61 yo. I might just take SS early at 62, but would not like it.
The subsidy is worth 11k yearly to me.

 

[simple girl]

We have a lot more years of uncertainty since we are younger - I'll be 51 (DH 55) in 2019. So 14 years to cover for me. Ah well, this is the risk of going for early freedom.

 

[footenote]

Contingency: Assuming ACA stays in place through 2019 (I know it may not!), I would have three years before Medicare.

I live in MN which had a state-wide high-risk pool pre-ACA. It's probable the state would re-instate one if ACA is struck down. HRP provides no choice of plans, but it was ok for covering major risks at an approachable premium cost for me.

(My 2019 subsidy will be about $6,000.)

 

[explanade]

If the ACA falls, what's more likely?

That congress will try to fix it or have some kind of replacement plan?

Or that congress will attack Medicare next?

 

[Aerides]

We have a lot more years of uncertainty since we are younger - I'll be 51 (DH 55) in 2019. So 14 years to cover for me. Ah well, this is the risk of going for early freedom.

Similar here. We don't have any pre-existing conditions (as of now), so there's that. We do also have a (very) small part time business, but that may help in access to things like group plans that might come back.

 

[simple girl]

Similar here. We don't have any pre-existing conditions (as of now), so there's that. We do also have a (very) small part time business, but that may help in access to things like group plans that might come back.

We both have serious pre-existing conditions, so no help there for us on that.

However, I did open my own very small part-time business that I will being doing in 2019. Maybe that would allow access to a group plan, but if I recall correctly those weren't so great for small businesses prior to the ACA - but I'm not 100% sure.

At a minimum, operating my small part-time business keeps my skills fresh, so if I should need to return to full work it won't be as hard. There is a huge demand in my field so I shouldn't have difficulty getting a full-time job, if needed. That's my safest contingency.

We are also looking at perhaps DH having his own small part-time engineering consulting firm for the same reason - primarily so he doesn't lose contacts. However, my limited investigation into this thus far has shown me liability insurance is quite expensive for engineering consultants. We are trying to nail more information down on that - it's on my growing "to do" list.

 

[joeea]

Part of me thinks if the ACA did go away, what would they do with all the people on it already?

In this case, "they" is your state.

So if you want to know what "they" would do, remember what your state did before the ACA became law. And then consider how and if the mood of the state regarding healthcare has changed since that time.

In my state (MA), I'm not at all worried. We had terrific healthcare (RomneyCare) before the ACA. Your mileage may vary.

 

[pb4uski]

.... However, I did open my own very small part-time business that I will being doing in 2019. Maybe that would allow access to a group plan, but if I recall correctly those weren't so great for small businesses prior to the ACA - but I'm not 100% sure. ....

The first two years that I was retired... pre ACA.. we had a small group plan through my LLC's membership in the local Chamber of Commerce. The state Chamber had negotiated small group insurance rates with BCBS.. available to any member of one of the local Chambers for their employees.

Our small group was 2.. me and DW... and the LLC's policy was that employees paid 100% of premium... $556/month for the two of us in 2012 and $629/month for the two of us in 2013.

I had created the LLC in anticipation of perhaps doing some part-time consulting for my former employer since they had mentioned it as I was heading out the door... as it turned out they never called me and I never called them... so the LLC never saw a penny of income or expense... but it was convenient havng it to be the sponsor of the small group plan.

 

[simple girl]

In this case, "they" is your state.

So if you want to know what "they" would do, remember what your state did before the ACA became law. And then consider how and if the mood of the state regarding healthcare has changed since that time.

In my state (MA), I'm not at all worried. We had terrific healthcare (RomneyCare) before the ACA. Your mileage may vary.

Well, I'm SOL since I live in FL. That's why moving is part of the contingency plan.

 

[simple girl]

The first two years that I was retired... pre ACA.. we had a small group plan through my LLC's membership in the local Chamber of Commerce. The state Chamber had negotiated small group insurance rates with BCBS.. available to any member of one of the local Chambers for their employees.

Our small group was 2.. me and DW... and the LLC's policy was that employees paid 100% of premium... $556/month for the two of us in 2012 and $629/month for the two of us in 2013.

I had created the LLC in anticipation of perhaps doing some part-time consulting for my former employer since they had mentioned it as I was heading out the door... as it turned out they never called me and I never called them... so the LLC never saw a penny of income or expense... but it was convenient havng it to be the sponsor of the small group plan.

Oh this is encouraging to learn about. I already have my LLC set up for my private practice so I'm ahead of the game on that part. Thanks for the info!

 

[zinger1457]

The first two years that I was retired... pre ACA.. we had a small group plan through my LLC's membership in the local Chamber of Commerce. The state Chamber had negotiated small group insurance rates with BCBS.. available to any member of one of the local Chambers for their employees.

Our small group was 2.. me and DW... and the LLC's policy was that employees paid 100% of premium... $556/month for the two of us in 2012 and $629/month for the two of us in 2013.

How much do you think you would pay for a similar policy today? The two years prior to ACA I was paying $180/mo for a HSA compatible HDHP, my HSA Bronze plan now cost $917/mo.

 

[pb4uski]

I pretty much know because the policy that we had is the kissing cousin of the BCBS ACA bronze policy... for 2019 the premium will be $999... so 8.7% average annual increase from the $556 in 2012... not bad compared to many other states and actually less than the increase of 13.1% the last year before ACA.

$180/month in 2012 was a screaming deal... even my employer subsidized HDHI was mch more than that.... that is part of why the increase seems so extreme.

 

[explanade]

I pretty much know because the policy that we had is the kissing cousin of the BCBS ACA bronze policy... for 2019 the premium will be $999... so 8.7% average annual increase from the $556 in 2012... not bad compared to many other states and actually less than the increase of 13.1% the last year before ACA.

$180/month in 2012 was a screaming deal... even my employer subsidized HDHI was mch more than that.... that is part of why the increase seems so extreme.

WAs it exactly the same?

Same coverage for preexisting conditions, no lifetime caps, etc.?

 

[pb4uski]

Not exactly, but substantially the same... high deductible for all years.. HSA for a few of the early years then not HSA eligible... not sure why. Pre ACA our state did not allow medical underwriting and prohibited lifetime caps. Networks have been the same all 8 years. Only real change has been that the deductible has crept up from ~$6k to ~$8k and premiums have increased (almost but not quite doubled).

 

[MichaelB]

If the ACA is repealed, it is replaced by nothing. The prior regulations would need to be introduced and approved once again, otherwise there is only current non-ACA healthcare regulations. There is no “back to before ACA”.

Prior to ACA states were obligated to sponsor “must insure” laws for business, but were free to interpret and implement locally. In Florida, this meant business had no obligation to insure, but if employers wanted to, insurance companies were obligated to extend coverage. Small businesses of 3 or fewer employees were categorized separately. Insurers were free to offer less comprehensive policies with some exclusions and priced like individual policies. The rates were basically uncontrolled, the multiple between lowest and highest for age groups was 10x. It was not robust, comprehensive coverage, and it was pricey. And it was definitely different around the country.

 

[explanade]

Even if there was a replacement law of some kind, there would likely be years of legal challenges.

People who want to RE would have to deal with uncertainty.

 

[Katsmeow]

Sadly, they will go broke and end up on Medicaid. This is terrible from both a human and cost perspective. .....Ultimately, people get care. It may be too late and the whole ordeal is beyond sad, but ultimately we don’t turn people away.

Not necessarily. In many states childless adults are not entitled to be on Medicaid except in some very limited circumstances involving some disabilities. Simply being sick and broke is not sufficient to get on Medicaid. That was the entire point of the Medicaid expansion. People could die simply because they were poor and could not afford treatment particularly for illnesses such as cancer or other illnesses that require treatment beyond emergency treatment. So, yes, people did get turned away and they didn't get care in some states.

I don't expect SCOTUS to disagree with the Texas judge. Robert's entire original opinion hinges on the fact that Congress has the power to levy taxes. No tax (penalty now gone), no power. Given that, if SCOTUS rules on a purely legal vs. political basis, I would not expect the Texas judge to be overturned

I would surprised if the Supreme Court upheld the broad sweep of the ruling. I would even be surprised if the ruling survives the Fifth Circuit. If it gets overturned in the Fifth Circuit, I would actually be surprised if the Supreme Court even took up the case.

This case has a lot of problems with it before you even get to Roberts. The first is the problem of standing. It would not surprised me in the least to see the Fifth Circuit overturn the decision just on standing alone and never even getting to the merits of the case (easiest way for them to overturn the decision, actually). Even so, you can find a boatload of articles online explaining why the argument on the merits is wrong. Even if you think that the Supreme Court would hold that an individual mandate with $0 penalty was unconstitutional (I am not sure that it would actually), that does not at all lead to a conclusion that the entire Act is to be overturned.

Here is a good article:

https://www.washingtonpost.com/opin...ism-impossible-defend/?utm_term=.7745d62281d2

Pretty sure I read the ACA does not have a severability clause. Ergo, if one part of the law is determined to be unconstitutional, the whole thing is unconstitutional.

Hard to believe they would have written this without severability, but believe that's the case..

I think it was a stretch for the ruling, but FWIK the law did not include a severability clause in it which almost all laws do... that would lead a court to decide all is OK or none is OK...

It doesn't work that way at all. Severability law is complex. It is not a simple matter of simply looking at a statute and seeing if it has a severability clause and then severing the offending clause if it does and not severing it if it doesn't.

The reality is that Congress is 2017 eliminated the individual mandate penalty but didn't repeal the entire Act. Therefore there is an extremely powerful argument that Congress itself thought the mandate was severable from the rest of the statute.

The opinion overturning the entire statute is really radically sweeping. This has a host of consequences which have no relationship to the mandate. Calories on restaurant menus? Gone. Improvements to the donut hole for Medicare recipients? Gone. I guess it is possible that the Fifth Circuit and the Supreme Court would uphold this (on the ground anything is possible) but upholding this would certainly be a major substantive change in law that would have a great affect on many other statutes.

 

[ShokWaveRider]

Not necessarily. In many states childless adults are not entitled to be on Medicaid except in some very limited circumstances involving some disabilities. Simply being sick and broke is not sufficient to get on Medicaid.

No, but it does get one a free trip to the emergency room at no real cost to the recipient. (Blood from Stone theory)

What I do not understand is that hospitals cannot turn anyone down (Not sure if that is a law), but we cannot mandate health care coverage. If everyone got basic healthcare, like catastrophic paid for by taxes, those who wanted more or better could buy it. I think some countries work that way. So at least basic coverage would have some kind of funding.