Who is worrying about ACA going away???

[Poopycat]

ACA

I am very worried. The reason I decided to keep working was to see how elections and Supreme Court decisions pan out for health care. I am so relieved I did keep working. I’d be downright terrified if I didn’t have employer insurance right now and had to rely on something that could disappear soon.

I do think that some states will step in and pass legislation. Some already have. I think NM and WA have passed laws that look like state versions of the ACA. A few states - someone mentioned them earlier - CO, VA, MA and VT, I believe - had laws on the books pre-ACA. Some states have passed (or may end up passing) laws to protect people with pre-existing conditions, and that’s good, but more than that is needed. They need to pass community rating and guaranteed issue so older and/or people with pre existing conditions don’t have to pay exorbitant premiums. And no maximum coverage limits.

Even if some states pass state versions of ACA, the federal subsidies would go away so many would still be priced out.

I still want to retire in July 2022 at the latest. By then, I hope there is resolution so I know what to do. I am guessing that I would have to retire in a state that offers the best protections. CO wasn’t on my original list of destinations but it is now. I suspect that WA, CA and OR will enact protections or strengthen their existing laws. But I think that some of the states I had some initial interest in as retirement destinations will be off my list. I will move out of the country if I have to, but would exhaust reasonable US options first.

 

[blueskyk]

Like many, we could not have retired 4 years ago without the ACA. We both transition to Medicare this year and talk often about the uncertainty we would experience if that wasn’t so. That being said, it’s hard for me to imagine that such a wildly popular program (warts and all) would not have some serious staying power (in principle) even if some narrow ruling on a nit of tax law appears unfavorable. But indeed, the unknowableness of it all is a big headwind to retire into.

Just speaking for myself, the whole topic of navigating HI in retirement has taken up far more oxygen in my life than I ever imagined. Sometime it reminds me of the tax code - an ever changing labyrinth of rules, laws and interpretations that have me looking for the skein of linen yarn that will help me trace my way into and back out again.

 

[EastWest Gal]

I went back to work in 2017 because of ACA flap in Congress. 6 months as an independent contractor, then 18 months on the payroll. I’m on COBRA now.

I too am worried. I can afford the HI, but what if I can’t get HI?

 

[GalaxyBoy]

Heck, I’ve been worried all along which is why we kept our insurance under DW’s ex-employer’s retirement plan. The availability of that was a major factor in my decision to retire early. We keep it because if we cancel we can’t get back on it. If I wasn’t worried about the ACA I’d likely buy a policy on the Exchange if it saved us money. OTOH, Brother and SIL have an Exchange policy and their premium is much higher than ours.

 

[pj.mask]

I think the continuous coverage aspect is going to be impossible for a lot of people. With many now working the gig economy and the unaffordablity of colbra - I wonder if people who loose their jobs with benefits will just take a chance without insurance (the average person doesn’t have the savings) until they can get a new job.
Would be better like 10 of the last 12 months so a brief stint doesn’t ruin it all (like if I switch jobs with a 2 week gap do I need to sign up for colbra for those 2 weeks?)

 

[ShokWaveRider]

We may go to Canada till DW is eligible for Medicare in 3 years. I am very happy with Medicare coverage and service in our area. Because of my pre-existing conditions I cannot really shift around. So I will not lapse my Medicare. I would even argue that Medicare is better than a lot of the other countries Universal Healthcare. We have Family in 3 Provinces in Canada and in the UK., both of which I am a Citizen. DW is Canadian by birth and US by naturalization and is eligible for Medicare when she is 65.
.

 

[finnski1]

DW will go on Medicare in November but I will only be 61 1/2 at that point .
So I am a little concerned but I am optimistic I would find a reasonable solution.

 

[H2ODude]

I don't think this question violates the rules, if it does please don't post it mods.

I understand the politics of ACA good, ACA bad in how it's dealt with by Congress and how it is perceived by people. My question is not about that. What my question is, is given the concerns stated in this thread by folks if ACA goes away in part or whole, WHO financially is likely to benefit by such a finding by the SCOTUS? I"m not trying to be controversial, but trying to figure what the demographics are of the people who would be happy that ACA went away? Would people with employer provided HI expect lower premiums or better coverage? I'm just trying to understand if there is a group/demographic out there of people who have a counterbalance to the views expressed here so far, other than the political satisfaction that ACA was done with.

We've been on MC for 4 years now, was able to extend my employer provided HI when retired at 60 (it was not cheap, basically COBRA for unlimited time) and both are fortunate in our good health, so have never really been that immersed in understanding the ins and outs of the various options and plans of ACA.

 

[karen1972]

Colorado checking in here.

There are four states that have enshrined in law many of the ACA protections. Colorado has

o guaranteed health insurance coverage for pre-existing conditions - https://www.colorado.gov/pacific/do...age-pre-existing-conditions-part-colorado-law

o community based pricing (not individual based), so pre-existing would not affect your rate versus others in your community

o guaranteed issuance

o limits on how much older people can be charge versus younger

and they instituted a statewide plan to provide a fund for "the really sick, those that use insurance the most" in order to lower the rates for the rest of the people.

https://www.colorado.gov/pacific/do...se-premiums-individual-health-insurance-plans

Massachusetts, New York and Virginia do similar (but not exactly the same) for pre-existing conditions.

zero chance I'll be leaving here as long as the ACA is under attack.

I'm concerned but as you outlined nicely our plan is if things go south, we will just move to a state that has better options.

 

[Toocold]

I think out of the likely scenarios, the worst one will be each state enacting laws that reflect some portion of the ACA. I think all sides agree pre-existing conditions will be covered. I'm sure my state will be similar to the ACA without the subsidies. We don't use the subsidies, so I'm not worried, but I imagine many people will be worried on this point.

2020 -- shockingly -- has been a bad medical year. My DD, who has never been sick in her life, all of a sudden started having stomach issues. An ultrascan, GI diagnostic, and an endoscopy procedure later, we have a bill for $5k to pay out of the blue. The overall charges were $10k. Wow, our healthcare system really is expensive.

 

[garyt]

I would think/hope that even if the ACA were deemed unconstitutional in say July ( I'm assuming they wouldn't take up the case immediately) it wouldn't just end the next day if there's no other alternative available. I'm hoping they wouldn't just let things fall into chaos.
And could somebody tell me what actually would be deemed unconstitutional about the ACA as it currently stands? I understood the forcing people to pay a penalty/tax aspect but what else now?

 

[pb4uski]

I think the continuous coverage aspect is going to be impossible for a lot of people. With many now working the gig economy and the unaffordablity of colbra - I wonder if people who loose their jobs with benefits will just take a chance without insurance (the average person doesn’t have the savings) until they can get a new job.
Would be better like 10 of the last 12 months so a brief stint doesn’t ruin it all (like if I switch jobs with a 2 week gap do I need to sign up for colbra for those 2 weeks?)

Most continuous coverage provisions allow for gaps in coverage... a Republican proposed bill in 2017 allowed a gap of up to 63 days. My guess would be that few people working the gig economy would be eligible for COBRA... most of them are probably uninsured or on ACA or perhaps a spouse's employer plan.

...The Republican bill would still require insurers to offer coverage to everyone, including people who have preexisting medical conditions, such as diabetes, asthma or even cancer. But it would allow states to opt out of the federal health law’s prohibition against charging sick people more than healthy ones. In those states, if people have a break in coverage of more than 63 days, insurers could charge them any price for coverage for approximately a year, effectively putting coverage out of reach for many sick people, analysts say. After a year, they would be charged a regular rate again. ...

Source: https://khn.org/news/preexisting-conditions-and-continuous-coverage-key-elements-of-gop-bill/

I think another big aspect will be ACA subsidies and whether if ACA is struck down whether Congress would continue financial help with health insurance premiums for low and middle income households. I hope they do because the fact is that the cost of ACA subsidies is modest in the whole scheme of things... especially when compared to the cost of having millions of people neglect their health because they can't afford health insurance. A 2016 CBO report projected the 2020 cost of ACA subsidies to be about $54 billion (for 15 million people... $3,600/pp) ... compared to the $326 billion subsidy for the tax exclusion of employer provided coverage (for 152 million people... $2,148/pp).

https://www.cbo.gov/sites/default/f...ports/51385-healthinsurancebaselineonecol.pdf

 

[pacergal]

I, too, am worried. We go on Medicare next year, but our kids need coverage and benefit from ACA.
I have not heard of any plans on replacement.
If it is ruled unconstitutional, would the State plans still be able to be in place or would they be outlawed also?
Not a lawyer, so have limited understanding of how it would work!
But, it would be a big mess!

 

[ceciledian]

Very concerned. But cannot take any action until the dust settles and we know what we are dealing with. May pick up a part time job for coverage or move to a more insurance friendly state. Both are drastic solutions given the pandemic and upheaval of a move.

 

[ShokWaveRider]

Does this warrant a poll?

Will you be affected by ACA removal?

Yes In a Major Way
Yes in a Minor Way
No

 

[bobbyr]

I'm concerned but as you outlined nicely our plan is if things go south, we will just move to a state that has better options.

Wish we could do that, but we are pinned down taking care of parents.

We are 62/57, retired with cobra ending Nov 30. Our retirement insurance is not affordable...I am going to start aca and keep fingers crossed. Worst case scenario, i would go back to work for a few years.

 

[Freedom56]

If ACA went away

We pay $1061 per month for a Bronze PPO with maximum $7500 out of pocket each. We get no subsidies and only use our insurance for our annual physicals and screening tests. We don't have any pre-existing issues but if our premiums were to increase significantly, I would consider self-insuring as we do with dental coverage and just pay for the blood tests and annual physicals and build a reserve with the savings. Over the last five years of early retirement, we paid $71,185 in insurance premiums and out of pocket medical expenses. We received $6232 of billed services for those premiums during that time-frame. If ACA went away, we would seriously have to look at self-insuring and building up our own health care reserves.

 

[DallasGuy]

My gut feel is that even if the supreme court takes this up, they probably won't decide the issue until next summer and people will have coverage through the end of 2021. I start medicare on 7/1/2021 so I feel like I should be safe for medical care coverage for the future. I'm lucky I suppose.

Having said that, I'm worried for other people that rely on the ACA for affordable health care and having pre-existing conditions covered. I have cancer and have been on cancer maintenance medications for about 7 years...they are very expensive. If I would lose my insurance, I would probably go broke within 5-10 years if I had to pay the full cost of my meds. Some people in this situation would simply just die. And I know there are many people in my same situation. I still don't understand why some people are trying to throw out the ACA without a suitable replacement in waiting.

 

[Rianne]

SCOTUS does not rule on the ACA until June 2021. They're hearing arguments in November. Who knows what could happen between then and now? Many changes in the law could happen before the ruling. I just hope for the best but prepare for the worst. We'll get Medicare in 2022.

 

[SecondCor521]

I would think/hope that even if the ACA were deemed unconstitutional in say July ( I'm assuming they wouldn't take up the case immediately) it wouldn't just end the next day if there's no other alternative available. I'm hoping they wouldn't just let things fall into chaos.
And could somebody tell me what actually would be deemed unconstitutional about the ACA as it currently stands? I understood the forcing people to pay a penalty/tax aspect but what else now?

If the SC deemed a portion of the law unconstitutional, I am unaware of any way they can say, in effect, "Well, this is unconstitutional, but we'll let it stand for a year so that Congress can enact some sort of replacement". I believe that any portion that is determined to be unconstitutional is effectively nullified at the moment the SC rules. This would be very disruptive, obviously, which is a big part of why I expect any SC ruling to be very narrow.

There is a case out of Texas currently before the SC this season. I'm sure you can google more details, and I am no expert on this lawsuit, but the gist of the argument is this: Congress can only enact laws that are under powers specifically granted to them under the Constitution. The SC upheld the constitutionality of the ACA a few years ago under the argument that the requirement that people buy health insurance or face a penalty was constitutional because the penalty could be a tax, and therefore fell under Congress' authority to enact taxes. In the 2018 tax law, the amount of the penalty was reduced to $0. The Texas case argues that since the penalty was now $0, that effectively is not a tax, and without a tax Congress has no constitutional authority to enact the law. It then goes further to argue that the entire ACA stands or falls as an entire structure, so the entire law should be deemed to be unconstitutional.

There may be other ACA lawsuits challenging its constitutionality on other grounds, but I think the Texas lawsuit is the big one that many people are referring to now with the Barrett confirmation hearings and vote coming up.

I, too, am worried. We go on Medicare next year, but our kids need coverage and benefit from ACA.
I have not heard of any plans on replacement.
If it is ruled unconstitutional, would the State plans still be able to be in place or would they be outlawed also?
Not a lawyer, so have limited understanding of how it would work!
But, it would be a big mess!

States can enact their own laws, of course. Anyone with standing and harm can file a lawsuit arguing that a state law violates either the state constitution or the US Constitution. If the court agrees with the petitioner, then the law would be nullified. State legislatures and the US Congress can always enact additional laws to try to implement something, keeping in mind what the courts have said in order to try to avoid enacting unconstitutional laws.

...

As an interesting side note, the laws themselves still exist, and you can find them as part of the state's or Congress' collection of statutes. It's just that they don't mean anything because they're considered invalid - the constitutions are considered to overrule statutes in that way.

I found this out when I went through a divorce. My state enacted some law a long time ago that said that in a divorce, men had to do X and women had to do Y. When I saw it I immediately thought that the statute violated the equal protection clause of the 14th Amendment. Sure enough, there is a footnote that indicates that the statute is unconstitutional, and so I didn't have to apply it to my situation. But the law is still on the books. The legislature could amend the law to remove it, but there really is no worthwhile reason to do so.

 

[pb4uski]

My gut feel is that even if the supreme court takes this up...

There is no question that they will take it up... they already have a case on the docket.

 

[pb4uski]

If the SC deemed a portion of the law unconstitutional, I am unaware of any way they can say, in effect, "Well, this is unconstitutional, but we'll let it stand for a year so that Congress can enact some sort of replacement". I believe that any portion that is determined to be unconstitutional is effectively nullified at the moment the SC rules. This would be very disruptive, obviously, which is a big part of why I expect any SC ruling to be very narrow.

There is a case out of Texas currently before the SC this season. I'm sure you can google more details, and I am no expert on this lawsuit, but the gist of the argument is this: Congress can only enact laws that are under powers specifically granted to them under the Constitution. The SC upheld the constitutionality of the ACA a few years ago under the argument that the requirement that people buy health insurance or face a penalty was constitutional because the penalty could be a tax, and therefore fell under Congress' authority to enact taxes. In the 2018 tax law, the amount of the penalty was reduced to $0. The Texas case argues that since the penalty was now $0, that effectively is not a tax, and without a tax Congress has no constitutional authority to enact the law. It then goes further to argue that the entire ACA stands or falls as an entire structure, so the entire law should be deemed to be unconstitutional. ...

If in 2021 we have a Democratic controlled House, Senate and WH, couldn't they just change the penalty from $0 to $1 (or $0.49), and at that point the argument that $0 isn't a tax is moot and the case goes away?

 

[Toocold]

If in 2021 we have a Democratic controlled House, Senate and WH, couldn't they just change the penalty from $0 to $1 (or $0.49), and at that point the argument that $0 isn't a tax is moot and the case goes away?

I thought that the individual mandate was considered unconstitutional, so there is nothing to penalize, even for $1.

 

[SecondCor521]

If in 2021 we have a Democratic controlled House, Senate and WH, couldn't they just change the penalty from $0 to $1 (or $0.49), and at that point the argument that $0 isn't a tax is moot and the case goes away?

Sure, a law like that could be passed in that scenario. Although there could be a timing issue. Oral arguments on the Texas case are due to be heard this fall. I don't know what the relationship is between the time that the justices hear the case and a decision is announced, but I think it certainly could be as short as a month or two. I think also the SC justices have the option to hold their decision (keep it private) for a period of time, which given the timing they may be inclined to do.

Of course, the SC could decide in favor of the ACA in the Texas situation, or decide on a technicality to throw out the lawsuit, or send the case back to the lower courts (don't know much about that option except that they've done it before).

 

[RunningBum]

Uncertainty is very unsettling, and when it comes to health and health insurance, that's really worrisome. I would agree with the posts that say everyone will probably still be insurable, but at what cost? The idea of self-insuring would make a major health issue the new leader of things likely to derail my retirement, so it'd have to be incredibly high for me to go without HI.