Thoughts about the ACA

[YellowSubmarine]

<mod note> this ACA discussion was originally in the intro thread for MrBojangles, here Hello, I’m from Pennsylvania, aged nearly 55.

As I look into this, what is Obamacare? I feel like this was created promising free health care for all and isn’t?

I actually looked into this about the time I was leaving the Federal government and that’s a call list you don’t want to be on. They harass you.

The ACA was created for the less fortunate. There are some out there, more fortunate than I that game the system. I don't believe that ACA was intended to be "free health care" except in extenuating circumstances. However, it was to remove the preexisting conditions from the uninsurable as well as meeting the health care needs of poverty stricken citizens. I would never game a system as such; as it akin to stealing from charity.

 

[Aerides]

The ACA was created for the less fortunate. There are some out there, more fortunate than I that game the system. I don't believe that ACA was intended to be "free health care" except in extenuating circumstances. However, it was to remove the preexisting conditions from the uninsurable as well as meeting the health care needs of poverty stricken citizens. I would never game a system as such; as it akin to stealing from charity.

The ACA is far broader than just to serve those less fortunate. It created a means for coverage for those who lacked employer insurance, or who could not get private insurance, and are not eligible for Medicare, or had exceeded laughable lifetime caps (like NICU babies could do). While it did also include an expansion on Medicaid in most states, it serves those far beyond the "less fortunate" - small business owners, early retirees (hi!), those with pre-existing conditions, gig-workers, freelancers, anyone not on a W2 with a company that provides insurance.

It enabled a great many of us here to retire early, not because of the finances/subsidies perhaps in all cases, but certainly the pre-existing issue, or the anxiety of having claims refused willy-nilly, or getting dropped every year.

 

[YellowSubmarine]

The ACA is far broader than just to serve those less fortunate. It created a means for coverage for those who lacked employer insurance, or who could not get private insurance, and are not eligible for Medicare, or had exceeded laughable lifetime caps (like NICU babies could do). While it did also include an expansion on Medicaid in most states, it serves those far beyond the "less fortunate" - small business owners, early retirees (hi!), those with pre-existing conditions, gig-workers, freelancers, anyone not on a W2 with a company that provides insurance.

It enabled a great many of us here to retire early, not because of the finances/subsidies perhaps in all cases, but certainly the pre-existing issue, or the anxiety of having claims refused willy-nilly, or getting dropped every year.

I think you reiterated what I said, ACA is for the needy, poverty stricken, preexisting conditions, extenuating circumstances, etc. But you fail to acknowledge the gamers of the ACA. I know multimillionaires that defer income for the sake of cheap health care. They spend more time in coping out (gaming the system) than they do contributing to the betterment of society (and paying their fair share)...Oh well, there's plenty occupation gamers out there.

 

[MichaelB]

I think you reiterated what I said, ACA is for the needy, poverty stricken, preexisting conditions, extenuating circumstances, etc. But you fail to acknowledge the gamers of the ACA. I know multimillionaires that defer income for the sake of cheap health care. They spend more time in coping out (gaming the system) than they do contributing to the betterment of society (and paying their fair share)...Oh well, there's plenty occupation gamers out there.

To reinforce what Aerides posted, the ACA is primarily to ensure we all have guaranteed access to health insurance that meets a minimum set of standards.

In addition, there is financial assistance for the many that find the cost unaffordable. The average cost of large employer provided coverage (the least expensive coverage) is about 1/3 of the gross median household income, which renders it out of reach of the typical household.

There are some people with enough assets to pay their own way but get subsidies. There is no data or evidence to believe this is more than a small minority.

 

[YellowSubmarine]

There are some people with enough assets to pay their own way but get subsidies. There is no data or evidence to believe this is more than a small minority.

"small minority" hmmm. 45m on the ACA...is 1% or 4.5m a small minority?

 

[MichaelB]

"small minority" hmmm. 45m on the ACA...is 1% or 4.5m a small minority?

We shouldn’t ruin an intro thread with another ACA debate, it’s not fair to the OP, so let’s take it to a new thread. At your convenience, but please bring along some supporting data.

 

[Dash man]

"small minority" hmmm. 45m on the ACA...is 1% or 4.5m a small minority?

You might want to check your math.
450,000 is 1% of 45m.

 

[YellowSubmarine]

You might want to check your math.
450,000 is 1% of 45m.

oops! sorry...I was called to diner when I threw those numbers out from a quick google search. And that 1% calculation, I totally mis spoke. It appears that 21m are currently enrolled ACA; and my 45m (44m) includes Medicaid. ApologizeI rushed it.

 

[imjustawarrior]

I think you reiterated what I said, ACA is for the needy, poverty stricken

I thought medicaid was for the poverty stricken. I thought one must be above the poverty level for ACA insurance; otherwise, one ends up with medicaid or some other state program. I know this varies by state.

I'm no expert.

 

[MichaelB]

I thought medicaid was for the poverty stricken. I thought one must be above the poverty level for ACA insurance; otherwise, one ends up with medicaid or some other state program. I know this varies by state.

I'm no expert.

You may be no expert but you summed up the difference between Medicaid and the ACA pretty well.

 

[Aerides]

But you fail to acknowledge the gamers of the ACA. I know multimillionaires that defer income for the sake of cheap health care. They spend more time in coping out (gaming the system) than they do contributing to the betterment of society (and paying their fair share)...Oh well, there's plenty occupation gamers out there.

Because I don't think that's terribly important or a big number...Or one man's "gaming" is another's..."benefitting from the law" like, taking all one's tax deductions.

I spent plenty of my working life contributing to society, and retired early. I have a policy off the ACA marketplace, and because my current income is not massive, I do receive a subsidy, as do many folks here. I also opted for a large deductible to make my plan work for me. Does that make me a dirty gamer in some folks eyes? Don't know, don't care. I paid plenty of taxes in this lifetime. The subsidies are but one small aspect of the overall ACA law.

Without the ACA, I don't think DH would be insurable on the non-employer market that existed before. Then we'd be stuck working for insurance, which is not good for anyone. Neither of us would have had retiree medical available unless we kept working for another decade beyond when we retired.

 

[jimbee]

Following the law is not gaming the system.

 

[Surewhitey]

Eventually we will take either backdoor Roths or ACA subsidies. Either way we get something out of the tax law. It'll probably be a wash either way & equal gains. Which way do you judge me poorly for?

 

[aja8888]

How does one get "affordable" health insurance if he is in a state that did not expand Medicaid and he is not able to make enough money to meet the minimum poverty level?

 

[RetiredHappy]

I never got to game the system because of my early/spouse's late retirement and our age difference. I did get to go on ACA and received subsidies for the one year immediately after we retired. I have been paying full freight since the age of 55 and I turn 63 this year. Since I have to pay full freight, I have elected to pay even more for better off-exchange plans where every top provider in my area accepts. It turns out that my plan also includes an extended network outside of my state. I have gone to California to see a rheumatologist with whom my PCP has referred me. I am envious of those who can manage their income to obtain ACA subsidies. The law was rushed through and not well thought out and hence the "loopholes". But overall, ACA provides a safety net to those with pre-existing condition, and it has met its intent.

 

[COcheesehead]

I went on ACA after a year on Cobra (big mistake) and I reported my income legitimately. It never resulted in subsidies, but I got premium tax credits. The income limits are lifted until the end of this year. It all flushes out on your taxes anyway.
I paid anywhere from $600 ish a month to now a high of $1100 ish a month for HSA compliant policies.The difference driven mainly by how much income I reported at sign up.
The coverage is what we wanted.
I do know people, my brother and a neighbor who pile up cash, report little income,skimp on their lifestyle ,get big subsidies and feel like they are ahead. I always wonder what the cash really could earn if invested properly.

 

[GenXguy]

There seems to be some confusion with the OP and some others.

The Medicaid Expansion is part of the ACA, not something separate.

 

[GenXguy]

I went on ACA after a year on Cobra (big mistake) and I reported my income legitimately. It never resulted in subsidies, but I got premium tax credits.

Premium tax credits are considered subsidies. There are also CSR (cost-sharing reductions) that some people can qualify for.

 

[COcheesehead]

Premium tax credits are considered subsidies. There are also CSR (cost-sharing reductions) that some people can qualify for.

I know, but when I posted about these in the past people seemed to differentiate between a subsidy and a tax credit. I don’t know why, just my experience.

 

[Irishgirlyc58]

How does one get "affordable" health insurance if he is in a state that did not expand Medicaid and he is not able to make enough money to meet the minimum poverty level?

You need to take that up with your state. They opted out of Medicaid expansion.
Call your local social services office and see if there are any state or county specific programs for people who fall into this category.

 

[aja8888]

There seems to be some confusion with the OP and some others.

The Medicaid Expansion is part of the ACA, not something separate.

Not all states opted in to Medicaid expansion, like here in Texas.

 

[aja8888]

You need to take that up with your state. They opted out of Medicaid expansion.
Call your local social services office and see if there are any state or county specific programs for people who fall into this category.

That call has been done with no success.

 

[Alex The Great]

I believe the problem is not in ACA but in extremely high cost of health care in US which many people simply cannot afford. Health care is not a privilege, this is a real need for people does not matter how rich or poor they are. This is where all this "gaming" starts.
On my opinion, there needs to be a kind of universal health care coverage for everybody does not matter if they work or not, not free but for a reasonable cost like in other countries.

 

[Gallaher]

I think you reiterated what I said, ACA is for the needy, poverty stricken, preexisting conditions, extenuating circumstances, etc. But you fail to acknowledge the gamers of the ACA. I know multimillionaires that defer income for the sake of cheap health care. They spend more time in coping out (gaming the system) than they do contributing to the betterment of society (and paying their fair share)...Oh well, there's plenty occupation gamers out there.

I did this, as you say “gamed the system” and yes I’m a multimillionaire…barley. Also, I paid a lot of taxes because of my high income job which caused me to spend 150 nights a year in hotels for over 20 years. Do I feel entitled? No. I could not believe how easy it was to get a full subsidy. Note, I did not make the rules just followed them.
I am a bit redeemable, my wife and I adopted three foster kids with no economic support. She had to give up her accounting career to take care of the kids.
You don’t really ever know the whole story.

 

[Irishgirlyc58]

That call has been done with no success.

Darn. Have they given any information at all or do you know if they just say-we have nothing else for you-or the person who is in need of medical coverage?