Who is worrying about ACA going away???

[MichaelB]

But states can implement an additional tax, to pay for assistance similar to current subsidies.

True. Much easier said than done, though. Mandating coverage terms in a state can be done by the insurance regulator. Increasing taxes is a major legislative initiative.

I would hope to see an ACA program that is actually less expensive and that provides better access to the providers a person would want to see. Maybe ACA with ala carte options to select what you actually need in the way of services, competition across state lines, and more volume leveraged drug pricing. Favored nations drug pricing makes a lot of sense, as well as allowing medicare to negotiate drug prices.

ACA has little ability to impact heath care costs, because 90% of all health care moves through employer provided insurance, Medicare, Medicaid or Tricare. Those programs have the heft and leverage to change the cost dynamics of health care.

 

[MichaelB]

May I ask how did you do this? I don't see any 2021 plan data on healthcare.gov yet.

BCBS Florida releases it’s prices early, before the ACA enrollment window opens. The 2021 prices have been published and can be seen at its website and probably some non-public insurance portals.

 

[Mr._Graybeard]

I would hope to see an ACA program that is actually less expensive and that provides better access to the providers a person would want to see. Maybe ACA with ala carte options to select what you actually need in the way of services, competition across state lines, and more volume leveraged drug pricing. Favored nations drug pricing makes a lot of sense, as well as allowing medicare to negotiate drug prices.

I keep hearing about the panacea of competition across state lines. Since states regulate insurance carriers, I wonder how this would come about. The federal gov't assuming the regulatory role? Not likely, I think.

 

[Toocold]

I keep hearing about the panacea of competition across state lines. Since states regulate insurance carriers, I wonder how this would come about. The federal gov't assuming the regulatory role? Not likely, I think.

The problem with this idea is insurance companies still need to negotiate with healthcare providers and without enough purchasing power, they have never been able to compete with an incumbent player. Plus you'll never see a blues plan enter another state to compete with another blues plan. National players already have presence in all the states and for the most part, they don't seem to have had a major impact. Large employers are trying to ban together as well, but again, not much impact yet (if ever).

Few recognize that most health systems are monopolies/duopolies for their local markets especially for inpatient and acute care, and having more "buyers" doesn't help competition at all -- econ 101. It only adds to administrative complexities.

CMS truly is the only payer that can move markets, as they control / influence about 50% of spend.

 

[PaunchyPirate]

Not 100% sure, I got an email from my HI broker, it had a link, I had to sign in, it certainly looked like the HC.gov site. They have done our ACA since inception so no reas0n to believe it is not good. They get their info directly from Florida Blue, as they are reps. I will look again it may be their portal they sent me to.

Interesting. Maybe insurance companies are free to give existing customer's that information (at least for their own plans) via hc.gov. My company has only notified me that my current plan is not being offered next year and that I will need to pick something new. They haven't offered the details of available plans yet though. Also, our state (PA) is leaving healthcare.gov and moving us to our own state exchange (pennie.com), so I'm not sure when I'll know my options. I'm guessing November 1st or a few days prior. Glad yours seems to work out for 2021.

 

[sengsational]

I'm in the "not worried" camp, primarily for the same reason I'm not worried about a market decline... Because if it happens, there's a whole bunch of us in the same boat, and my seat on the boat is as comfortable as any. If there are changes, there will be winners and losers, but how much rearrangement will there be? The medical industrial complex will be there before and after the words are read next summer. There's momentum that's going to be preserved, somehow. Will I still be able to get the PTC? I hope so, but I've banked savings since the first year of the ACA using the PTC, so, like I said, my seat on the boat is as good as any, so I'm not worried...chips will fall where they may, and I suspect very little disruption because the industry will make sure the gravy train keeps chugging along.

 

[explanade]

The problem with this idea is insurance companies still need to negotiate with healthcare providers and without enough purchasing power, they have never been able to compete with an incumbent player. Plus you'll never see a blues plan enter another state to compete with another blues plan. National players already have presence in all the states and for the most part, they don't seem to have had a major impact. Large employers are trying to ban together as well, but again, not much impact yet (if ever).

Few recognize that most health systems are monopolies/duopolies for their local markets especially for inpatient and acute care, and having more "buyers" doesn't help competition at all -- econ 101. It only adds to administrative complexities.

CMS truly is the only payer that can move markets, as they control / influence about 50% of spend.

This can't be emphasized enough.

Local markets determine the pricing. For instance, here in CA, premiums in Northern CA are greater than those in Southern CA because they have more providers down there, resulting in more price competition.

No way some insurer from North Dakota is going to come in and offer better prices since their insureds still have to go to the same local providers here.

People talk as if you can have a race to the bottom in HI, like you do with credit cards and other things.

 

[Aerides]

I don't "worry" about it because I can do nothing about it. I try to save worry energy for making new plans and changes.

But what can we do?

Go back to work? Hahahaha after 4+ years ER our resumes would be dusty, and we'd be working for pennies at some MC to literally just have insurance - bleh. Smaller companies wouldn't have to provide insurance - that's part of the ACA law that expanded the requirements to make more companies provide it.

Self-insure? Nope, not viable, also, DH now has a pre-existing condition that he didn't have 4 years ago... even though it's awfully cheap, it's a check-box.

One thing I'd hope might come back if it all went to heck-in-a-handbasket is small group plans. I have an LLC for my small home business. I'd join the local chamber or whatever groups might band together for small business insurance plans, for self-employed folks. These all disappeared with the ACA, so presumably some would come back.

And the other good point is we're in FL. BCBS is actually profitable here, so I imagine they'd still offer plans to some degree.

So until there's a reason to act, I'll put my head back in the sand, because there is absolutely nothing I can do in the meantime.

 

[W2R]

I am not worried about it, for myself, since I have never been on ACA. I am on Medicare as my primary insurance, with my federal employee/retiree BCBS Standard insurance as secondary.

BUT - - I am worried for anybody who has difficulty in getting insurance these days. I am not in favor of eliminating the ACA, although I'd be happy if it was improved or private insurance that was better or cheaper was available too.From what I have read on the forums, some people are not happy with ACA and I think that not feeling limited to ACA would help. It would be great if insurance options were so good, that nobody even wanted or needed ACA. But until the time if/when that day comes, I am opposed to abolishing the ACA.

 

[SALTedOut]

I'm currently in my last two months of COBRA. I have three options going forward. ACA, retiree healthcare or a private plan.

ACA: I don't qualify for any subsidies. I've looked into the Texas ACA plans and they are horrible. IMO, that is on Texas's leadership not the ACA itself. None of my or DWs doctors are on any of the plans. They are very expensive for what you get.

Retiree Healthcare: It will likely be the choice I end up with. The coverage is very good but will close a little more per month. About the same as an ACA silver plan in Texas.

Private Plan: This will be a separate post I'm about to make to get people's option. I contacted an insurance broker who recommended an Indemnity Benefit Insurance plan. From what I can tell so far the plan has fixed payments they pay you in "reimbursement" for different types of services. If the service is more you pay the difference and if its less you pocket the difference. It's not ACA compliant but penalties have gone away so that is less relevant. There is a max coverage amount per year and a max lifetime as well. It also comes with some accident and life coverage as well. I've only just begun to try to understand it but it seems confusing so far. But its about $400 less per month than my retiree coverage so its a possibility.

 

[euro]

I don't "worry" about it because I can do nothing about it. I try to save worry energy for making new plans and changes.

But what can we do?

Go back to work? Hahahaha after 4+ years ER our resumes would be dusty, and we'd be working for pennies at some MC to literally just have insurance - bleh. Smaller companies wouldn't have to provide insurance - that's part of the ACA law that expanded the requirements to make more companies provide it.

Self-insure? Nope, not viable, also, DH now has a pre-existing condition that he didn't have 4 years ago... even though it's awfully cheap, it's a check-box.

One thing I'd hope might come back if it all went to heck-in-a-handbasket is small group plans. I have an LLC for my small home business. I'd join the local chamber or whatever groups might band together for small business insurance plans, for self-employed folks. These all disappeared with the ACA, so presumably some would come back.

And the other good point is we're in FL. BCBS is actually profitable here, so I imagine they'd still offer plans to some degree.

So until there's a reason to act, I'll put my head back in the sand, because there is absolutely nothing I can do in the meantime.

Well, you can vote and support candidates who pull in whatever direction you deem appropriate.

 

[Aerides]

Well, you can vote and support candidates who pull in whatever direction you deem appropriate.

Of course, and I do, but that won't impact the outcome of the SC decision, from a case they are going to hear next month and announce next summer, which is the main reason for any current "worry" under discussion.

 

[Katsmeow]

I'm currently in my last two months of COBRA. I have three options going forward. ACA, retiree healthcare or a private plan.

ACA: I don't qualify for any subsidies. I've looked into the Texas ACA plans and they are horrible. IMO, that is on Texas's leadership not the ACA itself. None of my or DWs doctors are on any of the plans. They are very expensive for what you get.

Retiree Healthcare: It will likely be the choice I end up with. The coverage is very good but will close a little more per month. About the same as an ACA silver plan in Texas.

I am in Texas.

Until shortly before I went on Medicare I was on retiree healthcare. For the 3 months right before I went on Medicare (which was in an April) I did an ACA policy because I was in good health and it was so much cheaper. One thing I did like about the retiree healthcare was that it was a PPO with lots of choices. But, it was very expensive. That 3 months I was on ACA (I think it was a Blue Cross plan, don't remember) it was quite a bit cheaper. And, it had good options.

For a couple of years some of my kids have been ACA plans. I actually really, really like the plan they are on now. It actually makes the plan useful for people who don't have a lot of cash. The plan is with Oscar (which may not be available in all areas of Texas).

What I love about it, is that although like most ACA policies it has a large deductible doctors visits and some other tests are not subject to the deductible. So, even without silver cost sharing benefits, they can see a non-specialist for I think $25 and can see a specialist for $75. These is also a special amount for seeing urgent care. So basically unless they have to go to the hospital or have certain testing, the deductible doesn't come into play. Now my daughter recently had to go to the ER but she has cost sharing for her plan and I think her deductible is $250.

As far as doctor/hospital choices, they are reasonable. My own feeling that I have changed my mind on over the years is that changing doctors is usually not that big a deal. I even know people who keep paying their primary care doctor out of pocket but just make sure that the doctor sends them to in network places for tests and such.

I do pay a lot of attention to the hospitals. When I was advising my kids on the choice of insurance for this year, I looked carefully to see if any of the "name" highly rated hospital chains in the area were in network. And, they were. Every good hospital wasn't in network. But, even were in network, that it was fine. Also, I did look at the list of providers to see that there was a wide variety of choices and researched some of the doctors. They were fine.

 

[street]

I'm not worried about ACA disappearing either. I hope it doesn't but if it does I'm fortunate that we have the money to pay for insurance while some may not be able to afford insurance if ACA goes away.

It really has been great for us.

 

[wildbilly]

[MOD EDIT]

I live in Minnesota. Pre-FIREing I presumed that I would be able to get the states high deductible insurance for $200-$300/month. That would keep me from going bankrupt if I got cancer or such. Along came ACA and I was able to get the best insurance that I have ever had for a cheap price. That includes what I got for "free" when I first started my professional career(that only lasted 3 years). All I have to do is keep my income (mostly investment) below $25K or I have to go the the insurance exchange. This has resulted in changing plans of rolling over more of my income tax 401K to a ROTH IRA. So, I won't have as much to play with in the 60-65 YO range before I get to medicare (which is much worse than I have now but suitable). My plan thus is to have my social security (if I get any) pay the taxes and extra medical I will need and everything essentially stays the same (live frugally). TBD.

The other thing that happened is I am having health issues that I did not expect to happen until I was 65, I'm 55 now.

Thus I am very concerned about loosing my ACA which could force me to be a Walmart greeter down the road :/

 

[Emerson11]

ACA

First, both sides of the aisle are committed to forcing insurance to eat the costs of pre-existing conditions, even if ACA dies. Because of that, self-pay insurance costs will never revert to the pricing structures enjoyed pre-ACA. I retired in 2007 at 46, and paid approximately $300/mo for high deductible, hsa qualifying coverage for myself and my two college age children. 13 years later, I pay over $850/mo for just myself at age 59, and the deductibles are at levels that would bankrupt me if I were very sick for a long time. (Deductibles have more than doubled.) I don't qualify for subsidy, but it's certainly not because I'm living high.

My point is that insurance rates and deductibles have skyrocketed under ACA. If ACA were to go away, those rates would likely revert some, but insurers will still be required to cover pre-existing conditions, so rates would not revert to inflation adjusted pre ACA rates. For someone currently getting a subsidy, you might be surprised by how low the self-pay rates would be without ACA.

 

[AbbA]

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.

I had the same thought theoretically, but I wonder if those states have some rules against newcomers in such situation.
Also, as Scrambler said earlier he's very concerned of the ACA going away even though he lives in NY which is one of the states that has ACA type insurance protections.
So, I wonder how good it would be to move to another state.
I'm curious how health insurances work in these 'special states'. People get subsidies on the federal level, so wouldn't they disappear for all people who qualify for them regardless of their residence state.

I also wish to retire but political climate and healthcare situation keeps me in the job. If we didn't have children, it would be easier to relocate outside the country, but we are not that adventurous for the unknown.

 

[skipro33]

I'm worried that the alternative will be single payer and that my life earnings that included my retirement medical insurance will be absorbed into the mix for the greater good. California looked into being it's own single payer insurance carrier only to discover they would have to raise state income tax rates 400% to cover the expense. If ACA lets me keep the retirement medical plan I worked, earned and have now, then that's what I'd prefer. I pay $109 a month each for me and DW from my pension. The company pays just short of $2000 a month. I have $20 copay dr. visits and prescription costs, and $50 ER if I'm not admitted. That's it. I gave up a lot of wages for that medical retirmeent plan. I was on the union negotiation committees every 4 year contract to preserve that for those grandfathered in who started working there in the 80's when I started. Since then, medical retirement coverage is tiered so that now at most you can get 80% coverage after 25 years working at the business. Single payer would wipe out my funds to the point I could not afford to retire and after 8 years retired, age 64 this month and just diagnosed with cancer, life as I know it would be pretty much over.

 

[skipro33]

I also wish to retire but political climate and healthcare situation keeps me in the job. If we didn't have children, it would be easier to relocate outside the country, but we are not that adventurous for the unknown.

Please don't let these sorts of things hang up your retirement, or you'll never retire. When I was in the military and my enlistment was up, my CO tried to scare me with that sort of talk; how will you pay for your children and their health care. Military is FREE! And he was right, but I also knew my quality of life; short remote tours every 3 years away from those same children was not the trade-off.
Over my lifetime, several other what-if's would try to dissuade me from taking the leap to the next rung on the ladder. Many career choices, home sales and purchases, kids, etc. But at some point, I had to make the leap.
So just do it. You never know what life will throw at you and you don't want to regret working longer than you needed to if it involved sacrificing something else.

 

[ccjarider]

I do not believe Gov’t is a useful entity to supply HI. I would be happy if SCOTUS killed it.

Apparently just like with. SS, many folks just want others to pay their freight.

 

[Emerson11]

I do not believe Gov’t is a useful entity to supply HI. I would be happy if SCOTUS killed it.

Apparently just like with. SS, many folks just want others to pay their freight.

Agree! As noted in previous point. My self-pay insurance premium has sky rocketed since ACA, along with more than doubled deductibles. ACA is a Robinhood system.

 

[wildbilly]

I do not believe Gov’t is a useful entity to supply HI. I would be happy if SCOTUS killed it.

Apparently just like with. SS, many folks just want others to pay their freight.

I don't see it. I have looked at the ACA insurance exchange many times. It doesn't seem that high and is really really cheap compared to what employer/employee pays as a whole. I see ACA as option that is mostly NOT run by the government. Only organized by the government.

As far a SS goes. I would have been able to retire earlier and had plenty of extra money to pay for insurance if my SS was put into my account that I controlled like a 401K. Now I just hope to get some and enough to pay all the taxes when I withdraw from my taxable 401K's. TBD.

 

[timo2]

I'm worried that the alternative will be single payer

+1

It always struck me as shortsighted and corporate malpractice that the Health Care companies didn't fully embrace the National Corporate Plan (the ACA). Because the country will not tolerate going back to the old pre ACA days. And the only alternative to the ACA is the National Government Plan (Medicare for all). If the Health corporations had really wanted to stay in business for the long term, they would have embraced the ACA as the path to long term existence. I much prefer the corporations do the health care, but they really stepped in it big time, just for short term profits. :-( Perhaps they can still recover.

 

[LimaPop]

I do hope it goes away in some fashion, it’s too expensive and covers many things I don’t want or need. I’d like to find an affordable catastrophic only plan....

 

[ut2sua]

I do not believe Gov’t is a useful entity to supply HI. I would be happy if SCOTUS killed it.

Apparently just like with. SS, many folks just want others to pay their freight.

Bold is mine. I guess there is no issue here with xx millions not having HI if the SC kills ACA? I am one of the "others" since I have paid my max SS taxes in most of my working career (still currently working). There are those of us who have been happy to support the previous generations getting their SS $. They have earned it, and we want to live in a country with fewer folks not making ends meet.