<p>"One factor that may serve to mitigate it to some degree is the “mom factor”.
-How many we are talking about? Is number has any statistical significance at all?</p>
<p>How many are going to refuse to purchase insurance despite the carrot (subsidy) and stick (penalty)? There are no data, so we don’t know yet. In other words, you’re demanding a numerator in a ratio that has no denominator yet. It may be that the denominator doesn’t have any statistical significance at all. Or it may be large, so that the carrot and stick need to be adjusted.</p>
<p>The one thing we do know is that one of the major parties has launched a media blitz to try to make the denominator as large as possible.</p>
<p>While I am very much in favor of expanding healthcare to include everyone, there are some aspects of the ACA that trouble me greatly as we approach its implementation.</p>
<ol>
<li><p>The medicaid eligible folks in the states (like here in NC) that did not expand medicaid to include them. You have low income people that qualify for subsidies and will pay nearly nothing (or perhaps nothing?) for their healthcare after subsidies, and yet people with less income will not qualify for any subsidies at all. I think it unconscionable to go ahead with the program nationally that still has this huge gap in many states. </p></li>
<li><p>I am hearing local anecdotes of huge increases in premiums. These 2 comments were just posted on a BCBS feedback forum.
and,
</p></li>
</ol>
<p>Part of me is a little skeptical that maybe these are fake posts. I have not received my rate increase/premium notice yet. Even if I get a huge increase I should be eligible for subsidies that will give me a lower cost than this year, but I am very uncomfortable with the idea of huge increases that are offset by huge subsidies for some, while others are stuck with huge increases.</p>
<p>Last year we downgraded our plan, ie increased our deductible from $2500 to $3500, increased our copays by $15 and $25 and increase co-insurance from 20% to 30% to lower our monthly premium from over $1000 to $680. Waiting to see what happens next.</p>
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<p>Wow, I did not realize that in order for health insurance to be considered a business expense (ie - a tax break) it will now need to be bought through the exchanges. </p>
<p>As a small business who purchases insurance for our two employees (who happen to be H and myself) we’ve moved that particular expense from business to personal (schedule A) side on occasion. That is to say, that portion of the health care costs which are NOT the premium. Our premium has always been paid out of the business side because it is what qualifies us as a small group. So if I understand this correctly, all health insurance premiums will not be disallowed as a business expense UNLESS it is a policy purchased through the exchanges???</p>
<p>Again, wow…</p>
<p>I guess on the positive side, if D follows her plans to get a masters of tax accountancy she will have job security.</p>
<p>No. It’s still considered a business expense and deductible on the corporate return, but this year, and last, there was also a credit for providing health insurance to your employees. Starting in 2014 this credit is only available if purchased through the exchange.</p>
<p>“I think it unconscionable to go ahead with the program nationally that still has this huge gap in many states.”</p>
<p>A bad problem, no doubt. Yet I think it would be unconscionable to allow a handful of recalcitrant states to prevent tens of millions of citizens elsewhere from receiving the benefits of the law. I’m extremely sympathetic to the plight of poor people in Florida, Missouri, etc., but ultimately it is their job to get their state governments to be responsible. Speaking as an Illinoisan, I know about having a crummy state government, but it’s entirely our own fault, and it’s up to us to fix it or live with the consequences. I wouldn’t want some national program on education or transportation to be held up because Illinois couldn’t get its act together.</p>
<p>^^^Hanna, were you born with so much common sense, or did you acquire it through experience? You never fail to bring wisdom to this board, which I marvel at because of your age. You’re pretty amazing. Just had to say it.</p>
<p>The bad news arrived today. My wife and I (age 60) are paying $689.67 per month for our current plan with Blue Cross Blue Shield of NC. Next year our monthly premium for a plan that looks very similar, will be $1550.48. I am pretty sure we will qualify for tax credits, so we will likely end up paying less for healthcare even though our policy premiums will more than double. But I am still not happy with this, at all. What about people making too little to qualify for subsidies? What about people making too much? Do you think they can simply afford double their monthly payment just because they make more than 400% of the federal poverty level, or whatever the arbitrary cutoff level is? And the thought of me managing my income (which I can do) to make sure I make enough to qualify for tax credits, but not too much to disqualify myself, sickens me. What happened to the good old days when all I needed to do was maximize my income?</p>
<p>Somewhere in the ACA publicity I believe there was reassurance that policy premiums would not go up dramatically. Did I imagine that?</p>
<p>NJres,</p>
<p>did you look at projected rates in your state’s exchange? </p>
<p>I have insurance through work, but out of curiosity I looked for rates on the mnsure (MN exchange site) and they look ridiculously low (without any subsidies). I don’t think I could buy insurance that low if I go directly to BCBS. I looked at the most expensive plan.</p>
<p>If this is true and there is no “gotcha” then maybe going through exchange will be more affordable to you?</p>
<p>P.S. I am personally shocked at how low the exchange rates are. My husband thinks that even the most expensive plan will be full of exclusions.</p>
<p>lerkin, NC doesn’t have a state exchange, is relying on the Feds to run the exchange. I just checked it for the first time and there might be more reasonable plans available. Apparently Blue Cross Blue Shield is not participating because I don’t see any of their plans. </p>
<p>This raises the question: If one is eligible for tax credits and/or subsidies that reduce your cost to a fixed percent of income, is there any financial incentive to find an inexpensive plan? If our 2 person income is $25,000 we are supposed to get subsidized down to 4.51% of our income, which is $1128. That will be our subsidized cost of healthcare ($94/month, can you believe it?) no matter what the sticker price is of the health plan we choose. What am I missing?</p>
<p>Yes, NJ the Public was told that “the typical family would save $2500” and " that you could keep your doctor if you liked". Both were (I don’t want to say lies) so I’ll say heavily exaggerated.</p>
<p>
You are missing the fact that the subsidy is keyed to the 2nd lowest cost Silver plan in your region. If you choose a more expensive Silver, Gold or Platinum plan, you will pay more. If you you choose the cheapest Silver plan or a Bronze plan you will pay less. </p>
<p>So lets say that the 2nd lowest cost Silver plan is $800 a month and the family income means that you are only required to pay a premium of $100 a month. That means that the family gets a subsidy of $700 a month. </p>
<p>But what if that Silver plan is an HMO that they don’t like? They want a Silver PPO plan that pays $900 instead? or a Gold plan that cost $1000 a month? They would still get that same $700 subsidy, but the better plans would cost them $200 or $300 a month in premium dollars.</p>
<p>What if they never get sick, never go to the doctor? They want to comply with the law and have insurance for emergencies, but they don’t want to even pay $100 for insurance. They look at the Bronze plans, and they see one that costs $600 and another that is $700 to cover their family. They’ve still got that $700 tax credit – if they go for the $700 Bronze plan, then they pay -0- every month. If they opt for the $600 plan- I’m not sure, but I think they still pay -0- – I don’t think they can get a tax credit back for an amount that exceeds the total premium cost.</p>
<p>
Even the cheapest Bronze plan is required to provide the essential benefits liste here: <a href=“https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/[/url]”>https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/</a></p>
<p>I’m curious – what does your husband think can be “excluded” that is covered in your work policy? The main difference is that the health networks might be smaller, and deductibles are higher on the cheaper plans. It’s also very possible that maximum annual out of pocket is better on on your employer-provided plan – so the “exclusion” might be dollars. For example, if your existing plan has a $1000 deductible, pays 80% of health care benefits, with a maximum annual out of pocket of $5000… you aren’t going to find that on the exchange. Also employer plans often include dental – the exchange plans have basic dental coverage for kids, but not adults.</p>
<p>I like my plan and I get to keep it…but someone conveniently left out the fact that I will just need to pony up another 50%…</p>
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<p>Did you just turn 60 this year? I know that my old BS plan was based on an age 50-59 tier-- even if I could keep that plan, I would have been looking at a 45% jump in premiums based on last year’s rates, just as soon as I hit my 60th birthday. (Coming very, very soon)</p>
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<p>That’s the whole point. The government is going to help you out. The premium dollars are based on a new system that no longer can exclude the sickest – so if you were paying “healthy person” rates (as I have been), then that preferred rate category no longer exists. But that in itself was something of an artificial rate, achieved only by policies of excluding the people who were most likely to need health insurance from coverage. In other words, I got a preferred rate because my neighbor with cancer was left to die uninsured. </p>
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<p>In the non-Medicaid expansion states, they essentially need to engage in wishful thinking when they fill out the forms asking what their 2014 income will be. They need to say they think they will earn 101% of the FPL. They will need to file tax returns down the line, but the max the government can take back from them is $600. </p>
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<p>Would they be able to afford that amount without ACA? There were no limits at all on insurance premiums before, and insurance companies had a way of dropping people from coverage if they needed expensive health care services. The difference with ACA is that the policy is now - for the first time in history – guaranteed. It is guaranteed issue – you can’t be turned down for health reasons – and is guaranteed never to run out – you can’t ever be told that you’ve reached a maximum benefit level. </p>
<p>The 400%+ people can buy a cheaper (Bronze) policy and they may be able to buy policies structured to their needs from private insurers. </p>
<p>I’m at the cusp of the 400% mark - as I am self employed, income fluctuates somewhat, so I will probably qualify for a subsidy in some years and not others. I’ll buy an HSA-eligible Bronze policy off of the exchange. My maximum annual out of pocket will be the same with the Bronze as it would be with the Gold, but my monthly premium will be less. I’ll fund my HSA to the max, and I’ll use that account for the higher copay I get with the Bronze. </p>
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<p>So you never had a kid in college getting need-based financial aid? You never found yourself in the position where a bump in income meant that you were no longer eligible for a particular tax credit, such as the dependent care credit, or student loan interest deduction, or those other credits with phase-outs? </p>
<p>I also can manage my income. I’m self employed. I very much need a new computer! The one I am typing on is 6 years old. (Aaaugh! Blue screen of death!). Am I going to buy that new computer now? No way… I’m going to buy it in 2014!</p>
<p>Although the subsidies will help some, many will get crushed with the high out of pocket maximums. The self pay are getting screwed.</p>
<p>We’ve had a high deductible policy for years now, and haven’t had any issues with it – we put money into the HSA account, and draw upon the HSA as needed. Not sure why this would mean that self-pay consumers are “getting screwed”. (I have become a lot more aware of the differences in prices based on where a service is performed, but I don’t think that is a bad thing. Before the HSA, it didn’t matter, because my copay was indifferent to location.)</p>
<p>Calmom,</p>
<p>We didn’t discuss it. I just mentioned the rate and how low it was without any subsidies. I couldn’t believe it. We both thought it was too good to be true. Time will tell, because those are just projected rates. However, I am thinking that if the insurance is going to be so cheap, then it will be hard to be approved for certain treatments that your doctor wants you to have, but the insurance doesn’t want to pay.</p>
<p>For example, instead gamma knive, the insurance will just pay for radiation. </p>
<p>Anyway, this is just a thought, and maybe I am completely wrong.</p>
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<p>They do that now. And I’m sure they will continue to. Even for simple CT scans for someone with cancer, both of my insurance companies (I’ve had two since my recurrance because Dh’s company switched) have fought tooth and nail to keep me from getting routine tests to monitor my progress. Each time, which is every six months, doc has to personally get on the phone and spend 10 minutes arguing about why it’s important.
So yes, this will happen. It’s hard to imagine how it could be more difficult than it already is.</p>
<p>[Insurers</a> limiting doctors, hospitals in health insurance market - Los Angeles Times](<a href=“http://articles.latimes.com/2013/sep/14/business/la-fi-insure-doctor-networks-20130915]Insurers”>Insurers limiting doctors, hospitals in health insurance market)</p>
<p>“Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.”</p>
<p>“San Diego will have 204 primary care doctors to serve HealthNet customers”.</p>
<p>The lists of doctors haven’t come out yet for California, but the lowest priced policies will come with much fewer doctors and hospitals available to the policy holders.</p>