<p>The wiggle room is all of the adjustments in line 23-35. There may not be much wiggle room there for people who have already been maximizing those deductions. CC Parents should pay attention to lines 33 & 34 (student loan interest and tuition & fees deduction).</p>
<p>Have been experimenting with the Health Connector website to see what would happen for various scenarios with our D (who is currently on our health plan until she ages out at 26). Until you make at least 100% of the federal poverty guidelines, which is $11,900, you don’t get any subsidy because you’re supposed to get MedicAid. At $11,900, you pay a maximum of 2% of your income in premiums and get a credit for the balance. It will be tough living on that income, but at least you will have insurance.</p>
<p>Hopefully, our D will get a job with benefits before she turns 26, but I was curious about how this works in the interim. Also, they confirmed that she would still be considered a resident of the state H & I live in, even if she’s unemployed and living in CA, looking to gain experience and/or a job since graduating from college.</p>
<p>Our newspaper announced this morning that HI has the lowest premiums in the nation under the ACA–HMO Kaiser and BCBS called HMSA (which already insures 70-80% of our state).</p>
<p>I mentioned in a previous post that many parts of Obamacare are behind the scenes, where we as consumers see nothing, but that contribute a great deal to reducing the underlying cost of healthcare. </p>
<p>I just attended a presentation recently where a healthcare provider gave the interim results of a project aimed at harnessing multiple medical disciplines together, on a common medical record, to improve the care for the patient and to reduce the cost at the same time. It’s being done in tandem with one of the major universities who are studying the process and the results. The project is possible because ACA facilitates certain reorganization of care which I won’t go into detail on. </p>
<p>The results were highly encouraging. Their biggest success was in a sharply lowered rate of readmissions, meaning they had a higher rate of correct diagnosis and treatment. They were able to reduce the number of required full time equivalent physician positions by just over 2%. That means they will be able to treat a lot more patients with the same number of physicians, and do it better. </p>
<p>I know our day to day concern is if we have insurance and how much it costs. However, other parts of of the ACA law may ultimately contribute more to accomplishing lower premiums over time than just the competition of spreadsheeting insurance plans.</p>
<p>HI law has required all employers to provide health benefits if employees work at least 20 hrs/wk, so we have a higher % of insured folks than most states. I’m pleased that our premiums are low and coverage is good, so far. The healthcare providers are unhappy that their compensation is so low (close to Medicare, I believe). </p>
<p>Still glad our kids are covered until they age out at age 26. They will hopefully get the bugs out before D has to buy a policy in 2+ years, if she doesn’t have a job that offers med benefits.</p>
<p>Hayden, I am very encouraged to hear about that, and have no doubt some kind of coordination will not only reduce costs but increase efficacy! The second biggest adjustment for a newcomer to the American healthcare system next to cost for me has been what I consider to be an abject and wasteful lack of coordinated care it’s as if everyone’s operating in a a silo in terms of billing and intel!</p>
<p>There was nothing in the article you posted which even suggests a doctor shortage. I have also not heard even a whisper that medical schools are having a hard time getting students to attend.</p>
<p>Talking to doctors I know, it’s the tedious electronic medical records keeping that is causing huge job dissatisfaction. Instead of writing something once in the medical records, each time the patient visits, the electronic prompts require that informaton be entered over and over. It’s massively time-consuming and frustrating.</p>
<p>I actually had two thoughts in that post - one the looming doctor shortage that has been discussed for years, not just because of ACA. It isn’t that medical schools aren’t getting enough applicants. It is that there aren’t enough medical schools to train how many we will need in the coming years. </p>
<p>The link I provided discussed how some doctors feel like it was a mistake to go into their profession, in the first place.</p>
<p>I have now taken the federally offered training and passed the exams. I immediately had some questions about medicaid and subsidies, the insurance providers say to call HealthCare.gov. Those people say they cannot answer any questions until October 1, that they know nothing about Medicaid and it sounds like they won’t really know much about reconciliation of subsidies.</p>
<p>This implementation is going to be a mess for people in the loopholes, like the people who should now qualify for Medicaid, but if their state did not approve expansion, they don’t get Medicaid and don’t get subsidies.</p>
<p>There is also not clarity on what happens to some one whose income changes, if they start the year on Medicaid and then get a job with monthly income qualifying for subsidy & make that change and accept the subsidy, but then that partial year employment annual total income = Medicaid & no subsidy…now what? Pay back the subsidy?</p>
<p>"I actually had two thoughts in that post - one the looming doctor shortage that has been discussed for years, not just because of ACA. It isn’t that medical schools aren’t getting enough applicants. It is that there aren’t enough medical schools to train how many we will need in the coming years.</p>
<p>The link I provided discussed how some doctors feel like it was a mistake to go into their profession, in the first place."</p>
<p>I have no idea if there is going to be a massive shortage in the future but since population growth in the US is 0.7% I don’t see it - even with the addition of 30 or so million more who will have insurance. </p>
<p>As for doctors wishing the didn’t go into medicine - it doesn’t seem to be stopping anyone now from deciding not to go into the field. I also haven’t heard of doctors upping and quitting because of ACA - which was one of the talking points a few years back. </p>
<p>Hanna, so happy for you! Yesterday I heard some blow hard who was saying ACA would decimate entrepreneurship because who would start a business because they would have to pay for medical ins. for their employees. I just shook my head. </p>
<p>“I just don’t get the huge difference for Wyoming.”</p>
<p>Those states only have one or two insurers on their exchanges so they have no competition. I don’t know why so few insurers don’t want to do business in those states, but it’s one reason, imo, there should have been a public option. </p>
<p>“This implementation is going to be a mess for people in the loopholes, like the people who should now qualify for Medicaid, but if their state did not approve expansion, they don’t get Medicaid and don’t get subsidies.”</p>
<p>I believe people who already qualify for medicaid will still get medicaid in all states. It’s the people who are just above that income level but below the income qualification to purchase on the exchange who will get screwed in the states which have refused to expand medicaid. Perhaps people in those states need to organize and vote out the politicians who have created this situation.</p>
<p>My state (MN) will most likely not be ready to roll out exchange on October 1st. The web-site is ready, but people (for example insurance brokers) were not trained to assure security of information. Since we (in my state) had a huge bridge of privacy (the SSNs of about 1.7K insurance agents were disclosed), MN is taking an extra step to prevent this from happening with consumer data.</p>
<p>“Well, one thing of interest to small businesses like me is that we may be able to compete for talent without providing benefits because people can buy coverage at reasonable prices on their own.”</p>
<p>I think the blowhard’s point was that there will be no more Steve Jobs/Mark Zuckerberg et al due to ACA because if they become successful they will have to offer health insurance to their employees.</p>
<p>“Those states only have one or two insurers on their exchanges so they have no competition. I don’t know why so few insurers don’t want to do business in those states, but it’s one reason, imo, there should have been a public option.”</p>
<p>I don’t know about Wyoming, but my state (Washington) has only four insurers, because the state turned all the other applicants down. It’s not that insurance companies weren’t interested. Premiums will be high, no doubt, due to lack of competition. The insurance commissioners office turned down plans that were accepted by other states. Apparently in their desire to only accept the perfect plan, they forgot about the cost to consumers.</p>
it’s as if everyone’s operating in a a silo in terms of billing and intel!</p>