Obamacare on Life Support article

[Perspective]

Unfortunately, we're not going to hear here, from someone who benefits from ObamaCare - that family of four in rural Kentucky making $30K who absolutely hates ObamaCare and voted for Trump, and doesn't even know their state level health insurance plan is heavily subsidized by the evil ObamaCare; and that if it were actually repealed, would cost them dearly every year in either higher premiums or forgone health insurance coverage.

But why should we care about these "deadbeats," right?

I'll give you three..good hard working people I know who were not covered by insurance and enrolled enthusiastically  in Obamacare the first year.  All three dropped it as too expensive, or they thought it would be free and it wasn't.  Two are now on medi-cal and pay nothing and the third is uninsured by choice.  No benefit but to move more people onto the government dole.  And for that? Insurance for all the rest of us got worse.  Don't lift everyone up...drag all of us down so that its "fair" and equally crappy...Worked great don't you think?

Anecdotes aside, yes, at a basic level, when government inserts itself into any area, some people benefit and some people lose something. Too many "conservatives" start with the premise that the free market fairly distributes goods and services to begin with, and therefore most (all?) government interference is unfair.

Reasonable liberals start with the premise that the free market doesn't always distribute goods and services fairly, and that government interference can rectify some of the unfairness. Too many liberals take this too far, and try to solve everyone's problems with redistribution, which creates its own problems for the folks paying for it, and the folks receiving it.

 

[morekaos]

If it reduces government involvement and reduces my costs and saves money on the deficit...its a step in the right direction. What the CBO does not and cannot take into account is market force competition.  If you release the shackles on bushiness than I guarantee you companies will again use healthcare as a "benefit" not a right. They used to offer better insurance as incentives to its workers. Used to be healthcare and retirement was considered as part of a total package along with salary.  It should be again.

 

[Perspective]

Partially with you on prospective benefits of competition in this area, but I support divorcing healthcare insurance and retirement savings from employment. Again, not an easy task, but can be done.

 

[morekaos]

How can you separate them?  Everyone takes these "benefits" into account when looking at employers.  Even public sector jobs are marketed using retirement and health benefits as incentives and a way to cut up front salary costs (teachers and fire fighters).  I think that is healthy for a competitive healthcare market. Insurance companies have to adjust and offer better policies and terms in order to gain business.  Under Obamcare, the offerings were equal and generic in nature with no incentive to differentiate coverage that was dictated by the government.  This competition benefits the end user both in costs and product choice.

 

[Perspective]

We can separate health insurance and retirement savings from employment by ensuring that nobody is privileged or disadvantaged by not receiving the benefit from their employer.

e.g. Whatever tax incentives apply to these benefits inside of employment, should apply to these benefits outside of employment; or eliminate the tax incentives altogether to create a level field. Why should I be able to buy health insurance with a pre-tax subsidy from my employer and pre-tax treatment on my portion, while someone in the individual market cannot?

Why should I be able to put $18K pre-tax in an employer retirement plan, while others without an employer plan may not? Why should I be able to contribute the max to my employer retirement plan, while the IRS' Highly Compensated Employee rule limits some folks dramatically?

I'm not suggesting this is easy, or even sufficiently practical that it deserves discussion - just throwin' ideas out about unfairness in the healthcare and retirement savings markets.

 

[nosuchreality]

As for the ACA.  The ACA is a complete piece of garbage that has had a pretty substantial negative impact on my family.

how and why?

I wrote this earlier in this thread but it bears repeating...

I have always worked for Fortune 100 companies. Thank God i had my kids prior to ACA. Both C- sections cost me a $500.00  deductible.  Post ACA my 20 year doc went to concierge medicine ($2000.00 a year retainer so I lost my Doctor)  my deductible is now $6000.00, my former insurance is no longer a choice (I lost my insurance company) and my premiums are up 20% (where was my $2500/year savings?).  I am basically self funding with a catastrophic care policy...but abortions are covered...thanks ACA and Obama...that worked out great!!!

Fortune 100 with a health plan that has a $6000 deductible?  Did you take the high deductible HSA plan at it?  Basically in 2015, the max out of pocket was set at $6600 which means your plan basically goes from you pay 100% to the plan pays 100% over the course of $600 of service (which could be a single doctor visit and easily no more than two).  That was a very popular option prior to ACA at my spouses Fortune 100 employer...

 

[morekaos]

Yup, We offer HSA or HRA.  That is my family deductible to keep a PPO not the HMO. I only had 2 choices that the firm, in a letter, blames squarely on complying with Obamcare mandates.

 

[nosuchreality]

Yup, We offer HSA or HRA.  That is my family deductible to keep a PPO not the HMO. I only had 2 choices that the firm, in a letter, blames squarely on complying with Obamcare mandates.

Yea, the firm blamed ACA, they used it as cover to dump their expensive benefit plans.  Did you go back and check your annual total comp statement we're they brag about how much non-income they pay you in the form of benefits?  If I recall correctly my spouses firm kind of got caught on it the year after the switch when people noticed the drop in employer benefit contribution on the plans.

 

[peppy]

All the cool kids are on high deductible + HSA plans these days. But this has little to do with the ACA.

 

[Perspective]

The bottom line is, if you like eliminating pre-existing condition exclusions, the mandate, and the ACA taxes, as Republicans say they do, the post-ACA system still looks a whole lot like the current ACA system. We can dramatically reduce Medicaid spending/coverage and allow high deductible, low benefit coverage, and low coverage caps, and then see what happens. I support this for political reasons. Elections have consequences, and rural working class Trump voters have earned this.

 

[morekaos]

Yup, We offer HSA or HRA.  That is my family deductible to keep a PPO not the HMO. I only had 2 choices that the firm, in a letter, blames squarely on complying with Obamcare mandates.

Yea, the firm blamed ACA, they used it as cover to dump their expensive benefit plans.  Did you go back and check your annual total comp statement we're they brag about how much non-income they pay you in the form of benefits?  If I recall correctly my spouses firm kind of got caught on it the year after the switch when people noticed the drop in employer benefit contribution on the plans.

Wouldn't surprise me at all.  They also bumped up quite a bit in the deferred comp area to save current expenses. We got passed around like a cheap ho.

 

[riznick]

Is there a site that lays out all the pros and cons of the new proposal in a very easy to read format and is also unbiased?

I'd like something like what ballotpedia offers for local elections. 

 

[Perspective]

Is there a site that lays out all the pros and cons of the new proposal in a very easy to read format and is also unbiased?

I'd like something like what ballotpedia offers for local elections.

Read the CBO's report and The Economist article I posted today. Those are unbiased.

 

[riznick]

I'll speculate the rationale for prohibiting self-employed folks, including a husband and wife business, from purchasing a group health insurance plan is to avoid sham businesses created to attain possibly more favorable group plan rates and tax treatment.

Say people create a "sham" business for getting a group plan?  Why should the ACA care at all?  Even Obama called this clause insanely stupid (in other words).

It was an incredibly stupid clause, put in to a very stupid bill that was ignorantly rushed and made into law.

Prior to the ACA, group plans often had unfavorable rates.  Did that change after the ACA?  If so, why?  Wouldn't the ACA have eliminated that with it's own big group buy rates?

 

[Perspective]

I'll speculate the rationale for prohibiting self-employed folks, including a husband and wife business, from purchasing a group health insurance plan is to avoid sham businesses created to attain possibly more favorable group plan rates and tax treatment.

Say people create a "sham" business for getting a group plan?  Why should the ACA care at all?  Even Obama called this clause insanely stupid (in other words).

It was an incredibly stupid clause, put in to a very stupid bill that was ignorantly rushed and made into law.

Prior to the ACA, group plans often had unfavorable rates.  Did that change after the ACA?  If so, why?  Wouldn't the ACA have eliminated that with it's own big group buy rates?

Fair questions. I don't know the answers. There are folks in the healthcare industry who frequent this site. Wish they'd add value here, but I understand not wanting to comment on political threads and subject themselves to insults, etc.

My "sham" speculation assumed an individual in the individual healthcare market pre-ACA might receive a lower cost under a group plan, and therefore might want to declare him/herself a business.

 

[riznick]

My "sham" speculation assumed an individual in the individual healthcare market pre-ACA might receive a lower cost under a group plan, and therefore might want to declare him/herself a business.

Boy will it be fun when they have to pay the incorporation fees and file taxes 42 times a year for their Scorp.  Maybe they will hire an accountant.  The savings will be astronomical.

Yeah, I don't know. 

Getting kicked off my previous plan was one of many kicks in the balls.

BTW, I fully support UHC.

 

[nosuchreality]

Is there a site that lays out all the pros and cons of the new proposal in a very easy to read format and is also unbiased?

I'd like something like what ballotpedia offers for local elections.

Read the CBO's report and The Economist article I posted today. Those are unbiased.

It really depends on were you get your coverage today.

Fortune 500, you won't see much difference.
Small but over 50 firm, depends on your employer, my guess, they run for the door.
smaller firm under 50, you were porked then, you're porked now.
Individual market over 400% FPL, in California you need a completely new plan if you want it to qualify for the tax credit.  Hey, you get a tax credit if you get the new plan.  if you're over 50, haha, not enough to cover the 5X spread porking.  40ish, you break even, 30ish and under, yea! you get a credit and lower rate, if you get a compliant plan, which California currently has I think one.
Thru CoveredCA, you're porked.
Thru medicaid expansion, you're okay, until (AND IF), the State cuts due to block grants after 2018.

And if you have a pre-existing condition, no difference really between ACA and proposal, unless you want to play coverage gap roulette, which could be quite lucrative.

 

[Perspective]

Is there a site that lays out all the pros and cons of the new proposal in a very easy to read format and is also unbiased?

I'd like something like what ballotpedia offers for local elections.

Read the CBO's report and The Economist article I posted today. Those are unbiased.

It really depends on were you get your coverage today.

Fortune 500, you won't see much difference.
Small but over 50 firm, depends on your employer, my guess, they run for the door.
smaller firm under 50, you were porked then, you're porked now.
Individual market over 400% FPL, in California you need a completely new plan if you want it to qualify for the tax credit.  Hey, you get a tax credit if you get the new plan.  if you're over 50, haha, not enough to cover the 5X spread porking.  40ish, you break even, 30ish and under, yea! you get a credit and lower rate, if you get a compliant plan, which California currently has I think one.
Thru CoveredCA, you're porked.
Thru medicaid expansion, you're okay, until (AND IF), the State cuts due to block grants after 2018.

And if you have a pre-existing condition, no difference really between ACA and proposal, unless you want to play coverage gap roulette, which could be quite lucrative.

Sounds like a pretty accurate summary from what I've read.

 

[nosuchreality]

Is there a site that lays out all the pros and cons of the new proposal in a very easy to read format and is also unbiased?

I'd like something like what ballotpedia offers for local elections.

Read the CBO's report and The Economist article I posted today. Those are unbiased.

It really depends on were you get your coverage today.

Fortune 500, you won't see much difference.
Small but over 50 firm, depends on your employer, my guess, they run for the door.
smaller firm under 50, you were porked then, you're porked now.
Individual market over 400% FPL, in California you need a completely new plan if you want it to qualify for the tax credit.  Hey, you get a tax credit if you get the new plan.  if you're over 50, haha, not enough to cover the 5X spread porking.  40ish, you break even, 30ish and under, yea! you get a credit and lower rate, if you get a compliant plan, which California currently has I think one.
Thru CoveredCA, you're porked.
Thru medicaid expansion, you're okay, until (AND IF), the State cuts due to block grants after 2018.

And if you have a pre-existing condition, no difference really between ACA and proposal, unless you want to play coverage gap roulette, which could be quite lucrative.

Sounds like a pretty accurate summary from what I've read.

There is one other thing for the Fortune 500 / Russell 2000 type employers, there is a give-me in it for them regarding the 'voluntary' health assessment things they due for employees that let's them be more intrusive and expand the excess premium if you don't 'voluntary' get health assessed.

 

[Perspective]

These are growing in popularity - allow the insurance company to access personal/private knowledge about you and you'll receive a discount. Decline the offer, and you won't receive a discount - i.e. premium pricing applies.