<p>I’ve not done a great job keeping up with this thread over the last few days, so forgive me if this is redundant, but I believe a few posters own small businesses and have been awaiting guidance on SHOP. I don’t have much in the way of confirmed guidance, but may have a tidbit worth considering.</p>
<p>I was discussing year end strategy with my accountant yesterday, and he told me he has just discovered that the up-to 50% tax credit on small biz plans that meet the criteria (average wages 50 k etc) will actually only be good for two years, and then expire.</p>
<p>If this is true, my idea of switching to a SHOP HRA and funding my employees deductible with the tax credit differential would be ill-conceived because I’d be hit with a 50 percent effective premium increase after two years for all intents and purposes. I knew the idea was too good to be true :)</p>
<p>If true – and I’m never sure these days what’s true and what’s not (any insight, Calmom?) – I think its disingenuous policy insofar as if the idea is to attract small biz employers to the SHOP exchange who weren’t formerly providing insurance and who are still not mandated to, the expiration of credits is only going to cause another groundswell of rancor that is counterproductive to the end goal. Honestly, there are much simpler ways to implement policy. I am given to think this was a bone thrown to insurers to give a new market :)</p>
<p>In my case, the plan we’ve already been offering appears to be a platinum, but a funded HRA Silver would have in actual effect been much nicer practically speaking for employees in terms of out of pocket cost reimbursement. I may still go with it on principal but my funding commitment level may have to change. Good grief, I miss single-payer. I realize its not viable here, and I appreciate fully the dire necessity of ACA, but it doesn’t feel very “universal” to me in practical terms to tell poor people to possibly come up with 6k extra a year (OOP) and to make sure they have pediatric dental coverage The folks that wrote the law I’m sure meant well, but clearly have no grasp on how low wage earners actually LIVE ;)</p>
<p>Comparatively, my existing plan protects my one-earner-family-of-four from financial disaster or undue stress slightly better (OOP 2k x4 vs OOP 12k) than the exchange. And because we pay 70% of his family rate, its kind of a wash.</p>
And serious, respectful people can wonder if this is the way to do it in light of the numbers who will still be uninsured going forward. It’s pretty clear that this was never the end product that even the most ardent policy-makers envisioned. It was always expected that the original bill would have gone to committee and been cleaned up.</p>
<p>Actually, its really simple: queuing. We either queue by price (as we have historically in the US), or we queue by service (as they do in other countries with nationalized health care). </p>
<p>Designed to fail? And frustrate us all into saying yes to single-payer. Is that what your suggesting? Cause I don’t disagree, but I do dislike very much. It’s so deceptive and could completely destroy trust.</p>
<p>And it really seems more like a mess than strategy. No-one understands all of these quirky effects of this clause or that paragraph in the pile of rules and regs also known as ACA.</p>
<p>I don’t understand what “nobody read the legislation” is supposed to mean. Obviously people read it; you can’t write a long piece of legislation without reading it.</p>
<p>I think most voted on an idea, that being we have to do something. Very few understand all of the implications. Even it’s strongest supporters are starting to just go…WOW!</p>
<p>Obamacare was modeled on Romneycare, the functioning health care system in Massachusetts, and was written by the same people. It may fail; things fail in this world. But the proponents of the legislation have a lot to lose if it does fail, so the idea that it was designed to fail seems to be stretching.</p>
<p>This legislation was written by lobbyists and a certain number of senators. It was not read by the majority of those who voted on it or their staffs, either.</p>
<p>It was passed with reconcilliation and not an actual vote.</p>
<p>The proponents own this whole situation, however it turns out. </p>
<p>But that does not mean they either wrote OR read the bill. </p>
<p>Those are the cold objective facts and they should bug us all, regardless of our feelings one way or the other about health insurance companies and politicians. ;)</p>
<p>“Obamacare was modeled on Romneycare, the functioning health care system in Massachusetts, and was written by the same people.”</p>
<p>I thought that Romneycare was based purely on getting those who were uninsured, insured…not changing everybody else’s insurance policies and requirements. I didn’t think it caused immediate and huge premium increases, and insurance companies to drop policies as fast as they could. I also don’t think it made companies more responsible for covering health insurance, causing them to hire more people part time. At least that wasn’t the original plan. Am I wrong?</p>
<p>Also, my concern about giving information to healthcare.gov and state websites is not because there is so much information requested. It’s because if the contractor and govt geniuses who built these sites did such an incompetent job, why would we trust them to protect internet security? It wouldn’t surprise me if there was no security whatsoever.</p>
<p>Wow… This thread has become very very political…</p>
<p>Going back to insurance…</p>
<p>I was trying to compare the exchange plans with the off exchange plans yesterday. </p>
<p>I went to Anthem’s California website and looked at the plans and I did not see how out of network coverage is handled. Also, on Anthem’s website, Anthem said it did not have its provider list out yet. </p>
<p>Also, the kid is on your plan but he lives out of state and how that is handled is
murky to me.</p>
<p>It’s why I chose the plan with no network restrictions.</p>
<p>If you have network restrictions? Out of state, whatever? You pay out of network costs.</p>
<p>Or if you have your heart attack out of network, you pay out of network costs. I think only the emergency part, and not the ambulance, etc., or the lengthier stay associated, is covered. This is why you have got to be very careful reading what you sign up for, imho.</p>
<p>That’s a great question, dstark. A related question is for those that travel frequently on business. What happens if one gets really ill while OOS?</p>
<p>Keep clicking. The Anthem site I’m using says the provider list tool has not been finalized, but it will let you download a PDF of the most up-to-date list of providers in my state, by town, by specialty. I was able to confirm that my primary care physician is on the list – not that I have any real choice since their is only one ACA-approved insurance company in my state.</p>
<p>As far as I’ve been able to determine, the Anthem network for individual policies is the same, whether you buy an exchange plan or buy a plan direct from Anthem. They are not administering two different provider networks. I think the practical reality is that ALL health insurance policies will be dictated by the rules of the federal exchange, sooner or later. it’s just not practical to administer parallel systems. Maybe large employer group policies will remain different, but I doubt it.</p>
<p>There are differences by state I think, but not within the state. So, for our state, there are 3 choices in network type within each type of metal tier. Any doc anywhere, limited and restricted. But there is no real difference on the ACA or private. The private was just easier to sign up for. However, if someone is going to get a subsidy they should wait for dotgov!!!</p>
The folks that wrote the law I’m sure meant well, but clearly have no grasp on how low wage earners actually LIVE ;)</p>
</p>