Patient Protection and Affordable Care Act

[Texas Proud]

Nothing I can see, but what would happen if they had an accident, heart attack, or some other medical condition requiring immediate treatment?

Most accidents will get you in a hospital and taken care of..... maybe with big bill.... but then you have to decide if you want to pay them or not... I do not see this being the deciding factor in a number of people's decision....

 

[Purron]

Fine print or the market can change plans but the guaranteed coverage part of PPACA means I have just joined the January class of 2014. Roth/IRA taxes adds another wrinkle to keep life interesting.

Back on topic: I'd proceed with caution if the guaranteed coverage part of the PPACA is your final deciding factor for early retirement. As discussed extensively in this thread, there are lots of things that can (and probably will) happen between now and 2014 to impact all of our future decisions - retired or not.

 

[donheff]

Most accidents will get you in a hospital and taken care of..... maybe with big bill.... but then you have to decide if you want to pay them or not... I do not see this being the deciding factor in a number of people's decision....

I think it is a big factor if you earn a decent salary or are building a portfolio. Can't a hospital put a lien on your wages and attach assets outside of an IRA/401k? This seems like an area where health insurance acts like, well insurance. If you don't earn enough to care and have no assets, you probably qualify for a nice subsidy.

 

[Texas Proud]

I think it is a big factor if you earn a decent salary or are building a portfolio. Can't a hospital put a lien on your wages and attach assets outside of an IRA/401k? This seems like an area where health insurance acts like, well insurance. If you don't earn enough to care and have no assets, you probably qualify for a nice subsidy.

I agree that it is a big factor in most of our decisions... but that is because we think different....

Some people are willing to take the chance.... and most people who do will not have anything bad happen... I was only pointing out that if there were an accident etc., not having insurance will probably not be the deciding factor in your getting health care.... paying for that health care is the other matter....

 

[shotgunner]

This thread is a LONG read but it is a great thread. I currently have a HDHP w/HSA health policy which before Obamacare I thought would be my insurance plan until reaching Medicare in 10 years.

Using the KFF subsidy calculator for a single person like myself the cutoff between Obamacare subsidy and Medicaid is just under $15,303.

Medicaid is a state run program, Obamacare is Federal. Medicaid in NH is asset tested so I would never qualify.

So IF Obamacare stands and is funded, I will want a taxable income somewhere between $15,303 and $46,021. I have not figured out where the sweet spot is yet.

Presently I am working P/T without benefits but if I were to stop I might consider starting an income stream from several pretax retirement accounts to qualify for the subsidy OR I might decide to continue P/T work.

Obamacare as it stands will change the decisions of how people draw from retirement accounts, investments and how much they want to make from employment at a minimum. It would appear it may make early retirement easier for some folks.

The devil is in the details and politics yet to come.

 

[Purron]

Medicaid is a state run program, Obamacare is Federal. Medicaid in NH is asset tested so I would never qualify.

So IF Obamacare stands and is funded, I will want a taxable income somewhere between $15,303 and $46,021. I have not figured out where the sweet spot is yet.

My understanding is the PPACA would eliminate the Medicaid asset test. Take a look at the following link to the Federal Register and seach on the word "asset" to see the applicable sections:

http://www.gpo.gov/fdsys/pkg/FR-2012-03-23/pdf/2012-6560.pdf

 

[shotgunner]

My understanding is the PPACA would eliminate the Medicaid asset test. Take a look at the following link to the Federal Register and seach on the word "asset" to see the applicable sections:

http://www.gpo.gov/fdsys/pkg/FR-2012-03-23/pdf/2012-6560.pdf

Thanks. I was listening to the radio this morning and the commentator said that many of the governors of the 26 states who brought suit against Obamacare may choose to simply not participate. He said the PPACA carries no penalty for states that ignore it's mandates. The whole thing remains fuzzy.

 

[MichaelB]

Thanks. I was listening to the radio this morning and the commentator said that many of the governors of the 26 states who brought suit against Obamacare may choose to simply not participate. He said the PPACA carries no penalty for states that ignore it's mandates. The whole thing remains fuzzy.

The states have the option of not implementing health care exchanges, in which case federal gov't health care insurance plans will be offered instead. The states have the option of not expanding Medicaid. Everything else is mandatory.

 

[Purron]

Thanks. I was listening to the radio this morning and the commentator said that many of the governors of the 26 states who brought suit against Obamacare may choose to simply not participate. He said the PPACA carries no penalty for states that ignore it's mandates. The whole thing remains fuzzy.

Definately fuzzy for DH and I since we live in Virginia. Things could get very interesting for Virginians when we elect our new Governor in 2013.

 

[easysurfer]

I was getting my fix on the health care debate watching the talking heads on the morning shows from a couple of the major networks. On one of the shows, two state governors were guests and one stated in his state, they decided to go ahead and work in implementing the exchanges before the ruling. The other state's governor said the approach is to wait. So, after watching I did a search (the magic of the internet) and found this cheat cheat on USA Today, on how each state is approaching the exchanges.

Where states stand on implementing health care law

Also interesting is the numbers/percentage of uninsured in each state.

 

[NW-Bound]

Sick Around The World | FRONTLINE | PBS

The Frontline documentary looks at how various countries handle national health care. After watching this, it looks like our future National health care system is a mix of the German system, and Switzerland. I think with enough smart people looking at the lessons learned from other countries health care systems, we should be able to have the most fair and advanced system around!!!!!

The one thing i did take from watching Sick Around the World, there needs to be price controls on care, and insurance companies need to be non profit.

I'm learning a lot from this thread. Thank you.

I surely hope so (I highlighted a sentence above). With the American populace being as individualistic as we are, I do not see that other systems would get support and adopted.

It should be noted that while other countries have lower medical costs as a percentage of GDP compared to the US, their healthcare providers do complain of getting "squeezed". Modern medicine is expensive and people are living longer. There's no getting around that.

 

[M Paquette]

So, after watching I did a search (the magic of the internet) and found this cheat cheat on USA Today, on how each state is approaching the exchanges.

Where states stand on implementing health care law

Also interesting is the numbers/percentage of uninsured in each state.

That's a great reference.

One thing I've noticed is that a lot of folks think the exchanges are some sort of government insurance. They aren't. the exchange is supposed to be a combination comparison shopping guide, and central clearing house for pricing, plan, and subsidy eligibility. The insurance policies and HMO plans on both state run and the federal clearinghouse for states that don't want to play are all from private insurers and HMOs doing business in that state.

The California exchange, CalHEERS, is coming along nicely, and the web site should go live July 1, 2013 with enrollment opening October 1, 2013. (Accenture is the lead contractor, but in spite of that, the project is on schedule...)

One of the odd things I've noticed in many of the states that were protesting the expanded Medicaid coverage is that the states are reimbursing hospitals for treatment of uninsured/uncollectible patients. Very roughly, a tenth of all patients moving through hospitals fall in this category, but would be eligible for coverage under expanded Medicaid coverage. (The proportion varies wildly, by hospital location. Some are 5%, some see 20% without resources.). You'd think that they would welcome the Medicaid support to move these patients from the ER to clinics, home care, or managed outpatient care. That has worked out with positive results for chronic care patients in areas where local resources (major medical center, or co-ops or other community efforts) were available to cover such patients.


http://www.idph.state.ia.us/hcr_committees/common/pdf/clinicians/savings_report.pdf
http://www.naph.org/Publications/managingcareforuninsuredpatients.aspx

 

[MichaelB]

That's a great reference.

One thing I've noticed is that a lot of folks think the exchanges are some sort of government insurance. They aren't. the exchange is supposed to be a combination comparison shopping guide, and central clearing house for pricing, plan, and subsidy eligibility. The insurance policies and HMO plans on both state run and the federal clearinghouse for states that don't want to play are all from private insurers and HMOs doing business in that state.

I've probably added to that unintentionally by wording my last post poorly. The exchanges will sell policies that meet a set of federal standards, and if the state chooses not to set up the exchange the federal gov't will choose the policies.

 

[ERhoosier]

Very interesting thread, but IMHO there is too much uncertainty re ACA (& health ins issues generally) to rely on it for major ER decision. Obviously Nov election results could have huge effect on ACA. Assuming it survives relatively intact in 2013, there are many details remaining undefined. ACA (as amended) is large (over 900 pages)-
http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html
Implementation details from the gov't bureaucrats (inc. HHS, IRS, etc.) could have big impact on one's individual circumstances (e.g. state/corp waivers, specific tax form calcs, etc.). And I am still concerned about how ACA will affect actual day-to-day individual access to care (e.g. expansion of Medicaid, decrease in direct hospital support, DEcrease in private employer-based health ins, 25+ million still uninsured, etc.).
http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf

Bottom line is most not yet ER'ed should prob allow 6-12mo to see how the health insurance landscape settles out.

 

[samclem]

Bottom line is most not yet ER'ed should prob allow 6-12mo to see how the health insurance landscape settles out.

I'd agree with that. One procedural (not political) factor is that, with the penalties etc now clearly defined as a tax, those portions of the law may be subject to change under the "reconciliation" rules. This would eliminate use of the filibuster in the Senate to block changes, so those seeking to change the law would be able to do so with a lower bar.

No judgements or fingerpointing here, just a note that, for personal planning purposes, aspects of this particular law may be on a somewhat slipperier foundation than we'd thought before.

 

[donheff]

I'd agree with that. One procedural (not political) factor is that, with the penalties etc now clearly defined as a tax, those portions of the law may be subject to change under the "reconciliation" rules. This would eliminate use of the filibuster in the Senate to block changes, so those seeking to change the law would be able to do so with a lower bar.

No judgements or fingerpointing here, just a note that aspects of this particular law may be on a somewhat slipperier foundation than we'd thought before.

That has been my concern as well. Mitch McConnell intimated as much on one of the shows today. But I just saw another show discussing this and one conservative arguer opined that reconciliation would be opened and another argued that it is possible that those wanting to save the bill could separate the tax issues (e.g. the penalty) from other portions of the bill (e.g. preexisting conditions) leaving the later subject to filibuster. If so, the road to repeal could be very bumpy.

Still, plenty of cause for reserving judgement about what will be the shape of American health care circa 2014.

 

[easysurfer]

I was listening to the Ric Edelman radio show this morning. The first topic was the PPACA. He mentioned both sides. The various benefits and also the finanical impact to his clients.

If you wish to give it a listen...here's a link:

Listen to Past Shows | Ric Edelman

 

[rbmrtn]

I was getting my fix on the health care debate watching the talking heads on the morning shows from a couple of the major networks. On one of the shows, two state governors were guests and one stated in his state, they decided to go ahead and work in implementing the exchanges before the ruling. The other state's governor said the approach is to wait. So, after watching I did a search (the magic of the internet) and found this cheat cheat on USA Today, on how each state is approaching the exchanges.

Where states stand on implementing health care law

Also interesting is the numbers/percentage of uninsured in each state.

Good summary. I did some googling and found some specifics for my state. Sounds like we are a little ahead of others. From kaiser and state insurance board

Mississippi Builds Insurance Exchange, Even As It Fights Health Law - Kaiser Health News

Mississippi Insurance Department - The Patient Protection and Affordable Care Act

 

[easysurfer]

Good summary. I did some googling and found some specifics for my state. Sounds like we are a little ahead of others. From kaiser and state insurance board

Mississippi Builds Insurance Exchange, Even As It Fights Health Law - Kaiser Health News

Mississippi Insurance Department - The Patient Protection and Affordable Care Act

Does sound like your state is moving along and ahead. Reminds me of UnitedHealthCare, I believe, who even before the SCOTUS decision went ahead and said they are going to implement some of the provisions (such as allowing children up to age 26 to stay on parents' plan) regardless if the law passed or not.

 

[Midpack]

Bottom line is most not yet ER'ed should prob allow 6-12mo to see how the health insurance landscape settles out.

True enough. But even then I'd think PPACA is mostly appealing to those with pre-existing conditions. Most everyone I see who is most pleased that the SCOTUS has upheld PPACA is someone who's been denied (or expected/feared they'd be) coverage - to be expected. Those who were already eligible for HI have been (not conspicuously) quiet and not part of the media coverage. Even if it survives as-is (which is tbd), that won't tell you what it will cost. I hope people who already have private HI aren't assuming there won't be changes due to PPACA, that's not a given either is it?

We're a little closer to PPACA implementation. And 6-12 months from now there will still be quite a ways to go...

 

[easysurfer]

Bottom line is most not yet ER'ed should prob allow 6-12mo to see how the health insurance landscape settles out.

If I was depending on PPACA to be the last piece of the puzzle before I can FIRE and leave a bad w*rk enviroment, I'd be starting the countdown clock (cautiously optimistic, of course) right now for 1/1/14.

Since I've already FIRE'd, and have HI of my own, I'd say probably better to wait until 1/1/2015 or so to see what the landscape looks like then and let the first wave (guinea pigs ) of folks iron out the kinks before making a move.

 

[Spokane2303]

Thanks to the PPCAC; but, remaining cautious, we've moved our ER up to 7/2013 and will carry COBRA into 2014. If the PPACA falls apart, then we'll remain on COBRA till Feb. 2015. As we'd planned on paying HI privately without the PPACA, we're just hopeful that it survives and we'll be a little more comfortable in our ER.

Note: We live in Washington State where you are guaranteed access to health insurance without medical underwriting if you already belong in a group insurance through your employer. We moved to this state 9 years ago specifically because of this state law. The DW has poor health and we knew that HI was key to an ER. So HI availability has been a long term priority in our planning for ER. PPACA is just frosting on the cake!

 

[Mulligan]

True enough. But even then I'd think PPACA is mostly appealing to those with pre-existing conditions. Most everyone I see who is most pleased that the SCOTUS has upheld PPACA is someone who's been denied (or expected/feared they'd be) coverage - to be expected. Those who were already eligible for HI have been (not conspicuously) quiet and not part of the media coverage. Even if it survives as-is (which is tbd), that won't tell you what it will cost. I hope people who already have private HI aren't assuming there won't be changes due to PPACA, that's not a given either is it?

We're a little closer to PPACA implementation. And 6-12 months from now there will still be quite a ways to go...

I am one of those people. My plan is grandfathered, exempt from the process, but I have been studying the landscape, and eventually there appears no way to avoid being sucked in. When the insurance company eventually closes the policy down, I wouldn't be surprised if I get a double whammy. Higher premium by being included with non underwritten people, and being forced into a lower deductible premium. If the HSA's get phased out, it could be a triple whammy for me. I do think in balance when I drift into my 60s, there may be some benefit to this, so I will take a longer term positive view. BTW- I have read some articles that speculated that existing premium payers in the individual market will experience a 3-5 % increase in premium cost. I am very skeptical of that modest assessment.

 

[FinanceDude]

There are some good parts of the bill, but entitlements of this magnitude need a lot of careful thought behind them.

Congress has the ability to do some reworking which would go a long way to making it more palatable to all. This is no doubt the biggest piece of legislation in my lifetime.

 

[Telly]

I've read all the pages on this thread over several days, y'all were adding pages quicker than I had the time to read them!

One question I didn't see answered, unless I missed it. was "what is the definition of INCOME?"

Here is (I believe) the final consolidated document:

http://www.ncsl.org/documents/health/ppaca-consolidated.pdf

Section 1401 of the document, starting on pdf page 105 addresses this. In particular, see on pdf page 110:

‘‘(d) TERMS RELATING TO INCOME AND FAMILIES.—For purposes
of this section—
‘‘(1) FAMILY SIZE.—The family size involved with respect
to any taxpayer shall be equal to the number of individuals
for whom the taxpayer is allowed a deduction under section
151 (relating to allowance of deduction for personal exemptions)
for the taxable year.
‘‘(2) HOUSEHOLD INCOME.—
‘‘(A) HOUSEHOLD INCOME.—The term ‘household
income’ means, with respect to any taxpayer, an amount
equal to the sum of—øClauses (i) and (ii) revised by section
1004(a)(1)(A) of HCERA¿
‘‘(i) the modified adjusted gross income of the taxpayer,
plus
‘‘(ii) the aggregate modified adjusted gross incomes
of all other individuals who—
‘‘(I) were taken into account in determining
the taxpayer’s family size under paragraph (1),
and
‘‘(II) were required to file a return of tax
imposed by section 1 for the taxable year.
‘‘(B) MODIFIED ADJUSTED GROSS INCOME.—øReplaced
by section 1004(a)(2) of HCERA¿ The term ‘modified
adjusted gross income’ means adjusted gross income
increased by—
‘‘(i) any amount excluded from gross income under
section 911, and
‘‘(ii) any amount of interest received or accrued
by the taxpayer during the taxable year which is
exempt from tax.

I'm still trying to find a complete Section 911 of the IRS Tax Code to see what all the possibilities there are in Section 911. There are a multitude of links I can find to disparate parts of it, but none so far to the whole Section 911. The 1986 Tax Code is relevant, due to this note at the starting of the PPACA Section 1401 on pdf page 105:

Subtitle E—Affordable Coverage Choices
for All Americans
PART I—PREMIUM TAX CREDITS AND COSTSHARING
REDUCTIONS
Subpart A—Premium Tax Credits and Costsharing
Reductions
SEC. 1401. REFUNDABLE TAX CREDIT PROVIDING PREMIUM ASSISTANCE
FOR COVERAGE UNDER A QUALIFIED HEALTH
PLAN.
(a) IN GENERAL.—Subpart C of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 (relating to refundable
credits) is amended by inserting after section 36A the following
new section:
‘‘SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED
HEALTH PLAN.
‘‘(a) IN GENERAL.—In the