Speaking of ACA

[Rianne]

https://www.politico.com/story/2019/07/09/obamacare-lawsuit-1404171

According to many recent articles, ACA on shaky ground. Who thinks the ACA will survive for the next 3 years? My hope ruling gets repealed and takes a few years to get to Supreme Court. By then, hello medicare.

 

[Spock]

Health care (in this case its only health INSURANCE) is too important to make it a political "The other guy did it so therefore by default I don't like it" ping pong ball played between 2 distracted cats, both of which are high on catnip.
All I know is I'm 7 years from Medicare and paying full rate for a crappy high deductible policy (ignoring deductibles/copays/etc!) would increase my monthly burn rate by over 50% and my budget can't absorb that.

 

[ShokWaveRider]

I think it will affect a lot of us here (and our significant others) if it is deemed unconstitutional and removed. A disaster to the RE crowd IMHO.

 

[Aerides]

My hope ruling gets repealed and takes a few years to get to Supreme Court. By then, hello medicare.

(By "hope...repealed" I think you're referring to the ruling that the mandate is not constitutional, not that you hope the ACA gets repealed, iow, that the ACA survives?)

For everyone who would be 65 by the time the worst case happens, sure, no biggie for them, but it would leave many of us in the lurch.

DH and I for example: ACA coverage, already ER'd. More than a decade till medicare. If the ACA were struck down a few years from now we'd be in our 50's with several blank years in our resumes so returning to full time paid work with paid health insurance (along with many other hopefuls) would be unlikely.

And please spare me the "well you should go back to work now then...."

 

[ShokWaveRider]

We certainly hope it survives all the mortar attacks. I am sure it does more good than harm for those who really need it. Specifically Pre-Existing Conditions and preventative services. Regardless of whether one gets a subsidy or not, those provisions are still extremely valuable.

 

[Dtail]

DGF already on Medicare due to SSDI. I have 5 years until Medicare. I hope the ACA survives, but think it is too close to call right now.
At the very least, I hope the process takes awhile to get to the Supreme Court if necessary and then any new law would take a bit to implement.
Agree with @Aerides that most folks would have issues returning to work including me.
Plus will not work 30 hours in a greeter type job in order to receive medical.

 

[VanWinkle]

Change is hard, especially for those more experience folks out there. There may actually be a better way to get great health Insurance while keeping the pre-existing condition clause. I have been on the ACA for two years and think it has good parts and needs help in several areas. Cost is the biggest problem for those that can't control their income. Also the lack of asset qualification makes this an expensive program that also helps those that could afford to pay for their own(I'm included). I don't see the health insurance market(politicians) shutting down the ACA without an ample replacement. It might actually be a better plan.

 

[ShokWaveRider]

Unfortunately there has not been a replacement plan proposed, let alone and ample one. Until this happens I cannot see a suitable outcome.

 

[Spock]

Change is hard, especially for those more experience folks out there. There may actually be a better way to get great health Insurance while keeping the pre-existing condition clause. I have been on the ACA for two years and think it has good parts and needs help in several areas. Cost is the biggest problem for those that can't control their income. Also the lack of asset qualification makes this an expensive program that also helps those that could afford to pay for their own(I'm included). I don't see the health insurance market(politicians) shutting down the ACA without an ample replacement. It might actually be a better plan.

ACA has been law for 9 years and fully implemented for (?) with no "Plan B" proposed during that entire time. The mantra is "repeal", not "replace". So I am not optimistic that any sort of safety net will be in place when the current tight rope is cut.

 

[scrabbler1]

Unfortunately there has not been a replacement plan proposed, let alone and ample one. Until this happens I cannot see a suitable outcome.

And with split control of Congress, I don't see the 2 legislative chambers agreeing to anything quickly. Think about how long it took for the ACA to get passed with unified control of Congress and the White House. Each chamber would pass their own bill and blame the other chamber for being obstructionists.

 

[Dtail]

So if the the ACA gets repealed without the replacement in place, would it automatically revert back to the pre ACA coverages, or does the ACA stay in place until the replacement gets passed?

 

[ShokWaveRider]

So if the the ACA gets repealed without the replacement in place, would it automatically revert back to the pre ACA coverages, or does the ACA stay in place until the replacement gets passed?

I do not think we know. My suspicion is if you have a pre-existing condition, the insurance companies will have a new Tag Line....

"No [-]soup[/-] Insurance for you!"

 

[BeachOrCity]

So if the the ACA gets repealed without the replacement in place, would it automatically revert back to the pre ACA coverages, or does the ACA stay in place until the replacement gets passed?

It depends on your state. For all states technically HPPA (Health Insurance Portability) is still in effect, so theoretically IF insurers were offering coverage and you did not have a gap, you could still get coverage w/ preexisting conditions.

Some states (or in my case non state DC) have laws in place that will keep something going in the event it is repealed. Massachusetts is one. Washington DC is another. Both basically mandate coverage for everyone and in DCs case we run our own exchange so it would be business as usual, except for the 15% (in DC) of people who get subsidies. DC would also lose a ton of medicaid funding so that would be another big problem.

As far as your specific question it would be up to the last court receiving the appeal that if they ruled it unconstitutional how they structure and time a wind down of ACA. Could be immediate or over a period of years.

Best advise I ever got in my working years: "Don't worry about what you cannot control".

 

[marko]

I thought I just read yesterday that California approved health insurance for everyone. If ACA was ever repealed, I'd assume many states would follow suit.
We're above the threshold and pay $1300 a month for DW, so we're already there.

 

[Dtail]

I thought I just read yesterday that California approved health insurance for everyone. If ACA was ever repealed, I'd assume many states would follow suit.
We're above the threshold and pay $1300 a month for DW, so we're already there.

Would think it depends on the color of the state.

 

[MichaelB]

It depends on your state. For all states technically HPPA (Health Insurance Portability) is still in effect, so theoretically IF insurers were offering coverage and you did not have a gap, you could still get coverage w/ preexisting conditions.

I may be wrong, but I thought HIPAA only guaranteed coverage when moving from existing group coverage to individual. Guaranteed issue only covered business issued group, not self-employed or sole proprietor. There were no mandates or guarantees for individual coverage.

 

[24601NoMore]

I'd like to see it repealed and replaced with something better - lower premiums, lower deductibles - as long as coverage for pre-existing conditions was mandated. Both premiums and deductibles got absolutely crazy when the ACA was implemented. (Unless you're getting subsidies, it's now essentially un-affordable for most - eg: cheapest Silver PPO I could find in our area was > $15K / yr premiums with $7K+ deductibles - per person. That's potentially $29K in one year and simply insane - unless you get hit by a bus, it's essentially like not having insurance at all - and you get to pay a minimum of $15K/yr just to protect against catastrophic loss). HC plans were in general far better pre-ACA on those fronts.

Ideally, we'd go back to a free market system with the requirement that pre-existing conditions be covered. Finally passing the ability to buy insurance across state lines would go a long way in helping increase options. That way, competition "should" keep premiums and deductibles a lot more reasonable than they became when the ACA was forced. That's at least partly because the insurance companies could then charge pretty much whatever they wanted as for the first time in American history, there was a product you "had" to buy. That type of "forced purchase" is not going to keep costs down..if anything, it's going to add gasoline to the fire and rates are going to (as they did) skyrocket.

That said, I have next to no confidence (OK, pretty much none whatsoever) that with the current political climate the two sides could ever agree on ANYTHING, let alone something as important as a replacement plan..so, like most of the rest of you - we'd be up a creek if the ACA does get struck down and there is nothing that replaces it..as someone said up-thread..blank years on the resume is going to make the "go back to work" option pretty darn tough.

 

[VanWinkle]

Politicians want to get re-elected so there will be no repeal of the ACA without a replacement that insures pre-existing conditions. The original idea that once someone has a great plan, it will be hard to take it away. This holds true for plans that are not so great also.

 

[VanWinkle]

I'd like to see it repealed and replaced with something better - lower premiums, lower deductibles - as long as coverage for pre-existing conditions was mandated. Both premiums and deductibles got absolutely crazy when the ACA was implemented. (Unless you're getting subsidies, it's now essentially un-affordable for most - eg: cheapest Silver PPO I could find in our area was > $15K / yr premiums with $7K+ deductibles - per person. That's potentially $29K in one year and simply insane - unless you get hit by a bus, it's essentially like not having insurance at all - and you get to pay a minimum of $15K/yr just to protect against catastrophic loss). HC plans were in general far better pre-ACA on those fronts.

Ideally, we'd go back to a free market system with the requirement that pre-existing conditions be covered. Finally passing the ability to buy insurance across state lines would go a long way in helping increase competition. That way, competition "should" keep premiums and deductibles a lot more reasonable than they became when the ACA was forced.

That said, I have next to no confidence (OK, pretty much none whatsoever) that with the current political climate the two sides could ever agree on ANYTHING, let alone something as important as a replacement plan..so, like most of the rest of you - we'd be up a creek if the ACA does get struck down and there is nothing that replaces it..as someone said up-thread..blank years on the resume is going to make the "go back to work" option pretty darn tough.

There was no agreement between parties for the original bill, and there will be no need for agreement with the replacement.

 

[24601NoMore]

There was no agreement between parties for the original bill, and there will be no need for agreement with the replacement.

Well, unless there's some more legislative trickery again, like deciding a bill can be "deemed" to be passed, nothing is likely to pass both the House and Senate. The 60 vote threshold for Senate approval is quite unlikely in the current climate, as neither side wants to give the other a win..

Wish it were different, but if the (R)s couldn't get a "repeal and replace" passed when they had both the House and Senate, not sure I see how anything will get passed with split control of Congress..

 

[Spock]

I'd like to see it repealed and replaced with something better - lower premiums, lower deductibles - as long as coverage for pre-existing conditions was mandated. Both premiums and deductibles got absolutely crazy when the ACA was implemented. (Unless you're getting subsidies, it's now essentially un-affordable for most - eg: cheapest Silver PPO I could find in our area was > $15K / yr premiums with $7K+ deductibles - per person. That's potentially $29K in one year and simply insane - unless you get hit by a bus, it's essentially like not having insurance at all - and you get to pay a minimum of $15K/yr just to protect against catastrophic loss). HC plans were in general far better pre-ACA on those fronts.

Ideally, we'd go back to a free market system with the requirement that pre-existing conditions be covered. Finally passing the ability to buy insurance across state lines would go a long way in helping increase options. That way, competition "should" keep premiums and deductibles a lot more reasonable than they became when the ACA was forced.

That said, I have next to no confidence (OK, pretty much none whatsoever) that with the current political climate the two sides could ever agree on ANYTHING, let alone something as important as a replacement plan..so, like most of the rest of you - we'd be up a creek if the ACA does get struck down and there is nothing that replaces it..as someone said up-thread..blank years on the resume is going to make the "go back to work" option pretty darn tough.

Overtime I've dug up multiple graphs of health insurance premium costs, and the pre vs. post ACA trajectories are basically flat. There was a small bump when expanded coverage kicked in (per-exisiting conditions, kids until 26, mental health, etc), but if everybody wants to keep coverage for things like per-exisiting conditions in a post-ACA replacement, the price isn't going to go back down.


The insurance market place is still a competitive market from private insurance companies. Overtime, subsidies will trash the market just like they have education loans and everything else that is made artificially cheap. Since insurance company profits are essentially capped under ACA it will take longer for subsidies to skew the market because "creative accounting" would have to be created in parallel to hide the profits from rate increases.



https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878
https://www.kff.org/wp-content/uploads/2015/08/8775-exhibit-1-131.png

 

[aaronc879]

Seems to me it would be political suicide to go back to allowing no coverage or extreme cost coverage for pre-existing conditions. Removing subsidies would also be career suicide. Unless we go to some kind of universal coverage, ACA should be here to stay in close to the same form as now.

 

[ShokWaveRider]

The problem with the ACA, Repeal, deeming it unconstitutional, or whatever comes up next to undermined it, is every time it happens, it reminds people of the following and raises their anxieties, stresses and concerns.

1) Subsidy recipients are reminded that if they did not get a subsidy they may not be able to reasonably afford Health insurance that addresses many of their "Basic" needs.

2) Non recipients are reminded of how much they currently pay, and "some" (Not All) resent others getting the subsidies.

3) The uncertainty and alternative is so uncertain that it creates more anxieties and stresses for all.

All seems so unfruitful to me rather than staying with current law and the status quo. It would probably be more cost effective on the taxpayer not having to fund all the lawsuits etc.

Personally I am an ACA advocate and believe that the most important issue of our time in the USA (Healthcare coverage) is regularly toyed with as if it is expendable. All CITIZENS and Legal Immigrants should be entitled to adequate Healthcare coverage. I find it terrible that so many folk would lose their healthcare and bankruptcies could increase exponentially if the ACA was repealed.

However in our case at least we have options, that we WILL consider if the Sh** hits the fan. All very viable.

1) Move to a state that maintains the ACA HC general mandates or adopts universal HC. If taxes are higher so be it, you get what you pay for. I would rather it was controlled by the local governments than by the insurance companies.

2) Move to a country that has proper universal healthcare, pay the taxes and not have to worry about it anymore.

Someone above said do not worry about things one cannot control. We are lucky we have some control, many others do not have any.

 

[24601NoMore]

Overtime I've dug up multiple graphs of health insurance premium costs, and the pre vs. post ACA trajectories are basically flat. There was a small bump when expanded coverage kicked in (per-exisiting conditions, kids until 26, mental health, etc), but if everybody wants to keep coverage for things like per-exisiting conditions in a post-ACA replacement, the price isn't going to go back down.

https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878
https://www.kff.org/wp-content/uploads/2015/08/8775-exhibit-1-131.png

The first article linked shows a 27+% increase in average per person cost between signing and 2017. But inflation was only 12% during that time..so, HC increased >2X inflation by 2017..would it without the ACA? Hard to say..

The bigger issue, though, is deductibles. I haven't seen any data (but would like to) showing what's happened to average deductibles since the ACA was signed. That's probably my biggest beef with the law - I simply don't remember $7K or nearly $8K ($7,900) per person deductibles with plans that cost > $15K for two, pre-ACA. That's the crazy part..my deductibles pre-ACA were $500 - $1,000 or worst case, $1,500 per person. Never $6K, $7K or nearly $8K (max this year I believe under law is $7,900 per person. REALLY?!)

I don't have as much of an issue paying $15K'ish for 2 mid 50/early 60 people, but the deductibles make the insurance all but worthless - unless you get hit by a bus..

 

[ncbill]

IMHO subsidies are the biggest perk of the ACA...the vast majority of people on ACA plans are receiving subsidies.

So even if Congress were to pass legislation mandating coverage for pre-existing conditions, few would be able to afford such insurance without the generous subsidies currently offered under the ACA.

Those subdidies, of course, remains a huge incentive for those who wish to retire early & who can "manage" their mAGI to qualify for the subsidies.

I suspect that's more of us in LCOL/MCOL areas than HCOL/VHCOL areas.

If my spouse's employer didn't offer health care coverage a subsidized ACA plan would be much cheaper given our income, location, and household size (~$100/month vs. our current ~$900/month)