<p>Mandated coverage is only one small part of state laws that govern insurance. It wouldn’t break my heart if all insurers across the country were allowed to ignore any state mandates about coverage requirements and just sell ACA-compliant policies everywhere, but I want the consumer protections (such as they are) I get from state regulations. And I don’t think you want Washington DC to be reviewing all rate increases for every insurer, either. I’m guessing you’d be happier having that done at the state level.</p>
<p>California requires insurers to cover some stuff I think is junk that shouldn’t be covered. But that has almost nothing to do with California’s high insurance prices.</p>
<p>Dietz - The Medicaid “clawback” basically means that if you receive Medicaid benefits due to low income but die with assets the Feds can decide to snatch up your house or whatever to pay for your care. CF’s fixes are fine but who pays? The basic problem is too many people cannot pay and most can barely pay. It’s unaffordable. </p>
<p>My first four proposals don’t cost much. Enforcing existing laws costs something, but then again if the transgressors are fined, the enforcement costs might be very small or even negative. And I’m guessing that nobody in this chat is saying that insurers should be allowed to flout the law because we can’t afford to enforce the law.</p>
<p>I didn’t make a specific proposal for fixing the cliff, but probably any specific proposal I would agree to would cost some money. So, that’s true, that would have to be paid for somehow. I’m really just waving my hands here: I think the cliff is bad, bad tax policy, and it should be fixed, and I don’t know how to fix it. </p>
<p>Capping insurance costs at 9.5% of income for everybody would be one fix, and I don’t know how expensive it would be, plus it might have some other bad effects. It would be interesting to know how many people are affected by the cliff. It’s probably a small percentage of all insurance buyers, mostly older people in expensive states.</p>
<p>First, we need more people with jobs, Emily. I don’t see this so much as a health care problem, at all. Although, obviously there were problems with the old system and there are problems with the new system. And, it’s a safe bet there will be many more or more of the law would be enacted. You don’t delay the wonderful. The elephant in the room in all of this is the ballooning number of people in poverty. Whether they can’t afford food, housing, health care, or college is a distraction from the fact that they are poor and there are too many of them. That is the real problem. Current economic policies are not helping. And, generally when you subsidize something it does not get cheaper.That is a fact. Look at college costs if you want an example.</p>
<p>Paid for? I don’t think you can buy a growing economy. But, clearly another approach is needed. This stagnant thing has been going on for a ridiculously long time. </p>
<p>“I don’t think you can buy a growing economy.”</p>
<p>Of course you can. States do it all the time to get companies to relocate. Do you think the tax breaks they are given don’t cost the taxpayers of that state anything? </p>
<p>You have said the problem is too many poor people and too few jobs (though I disagree with that for the most part - as I believe there are enough jobs but the vast majority of them don’t pay a worker enough to live on.) </p>
<p>So tell me what your solution is to fix those problems? </p>
<p>Also, what is your proposal for making health insurance affordable for a family earning the median income (about $65K for a family of 4) who obviously have jobs and are not poor and now qualify for a subsidy under ACA. </p>
<p>"Of course you can. States do it all the time to get companies to relocate. Do you think the tax breaks they are given don’t cost the taxpayers of that state anything?’</p>
<p>They shouldn’t. The goal of those tax breaks is to bring more money into the state thru the new jobs generated by the business that they are attracting. Otherwise, what’s the point? If the cost goes up and that subsidized family is now buying a more expensive product with the help of a subsidy there are other hidden costs involved. And, they will continue to climb. ACA also includes a big bunch of tax hikes that affect everyone in a variety of expensive ways. Now, I really have to get back to work. Sorry. </p>
Rather than me questioning your reading list, LF, would you just throw out a percentage as to what was inserted into the ACA by those who didn’t vote for it? </p>
<p>Under Obamacare, every policy, even if it is packaged as a PPO, will, in effect, become a disguised HMO. The govt and the insurance companies are now in the business of limiting your choice of providers, a welcome development for them and a disaster for consumers.</p>
<p>The 9.5% applies to the premium. When you add in deductible and then up to max oop, it can go way beyond. Say that 65k family is paying 6175. If two meet, say, a 3k ded each, it’s now just under 20%. Different under different plans, sure. We’d need to look deeper than premiums.</p>
<p>They shouldn’t. The goal of those tax breaks is to bring more money into the state thru the new jobs generated by the business that they are attracting. </p>
<p>Accept they do cost the taxpayers huge amounts of $$$. </p>
<p>“If the cost goes up and that subsidized family is now buying a more expensive product with the help of a subsidy there are other hidden costs involved. And, they will continue to climb. ACA also includes a big bunch of tax hikes that affect everyone in a variety of expensive ways.”</p>
<p>You have no idea if this family of 4, prior to ACA, had any insurance or if the type of insurance they could afford was adequate. So again, I ask - what is your solution to providing this typical family of 4 affordable health insurance which is adequate for their needs and doesn’t cost the government anything? </p>
You call it complaining, I call it vetting for all the lurkers (of which there are probably a lot more than dietz or Flossy could ever put on buses for that protest road trip to the Mall).</p>
<p>The ACA could be 95% eviscerated and it still wouldn’t technically be repealed, so y’all might want to find another whistle for walking past the cemetary. The challenge of coming up with a better version is kind of tough, since the goal itself - affordable and quality care for everyone - probably isn’t. Not affordable, that is, which is kind of the point.</p>
<p>Cutting the lawyers out of the system is something that might make a difference. Funny it didn’t make the cut this time, isn’t it?</p>
<p>now in the business of limiting your choice of providers<br>
Maybe if you rephrased some of your assertions GP, we could follow. I have always needed to ensure my potential providers accepted my insurance. Or make the choice to pay out of network charges. Right now, I have virtually no restrictions under BCBS, as they and my state formed all this differently than yours. Any doc taking any BCBS, takes it regardless of whether the policy is exchange, direct or employer-based. Broad participation.</p>
<p>There is a difference between vetting and being an outright naysayer. One checks, the other assumes it’s crap, from the get go.</p>
<p>Why don’t those CA docs join the networks? Because they want to be paid more. Who is examining this expectation and its fairness? </p>
<p>Yow. You can say, well only 15% were uncovered, it’s a number. Can you take the same stand toward those whose rates went up? It’s a number, just a percent? Or is it more sympathy for those whose rates went up, than for those previously without? </p>
<p>Anyone know what percent went up? For real, not some projections by this pocket or that, this political stand or that one, some media outlet looking for attention. Just being cancelled doesn’t count. And subtract “normal” increases. Do we know?</p>
<p>“So, the first step in finding a solution is to accept the system will never be equal, fair or equitable. News flash, nothing ever is. If we’re willing admit this, instead of moralize about the horrible nature of reality, we can start proposing solutions.”</p>
<p>Here is my solution. Every business, not matter how small must provide health insurance to all their employees and the employees family no matter how many hours they work a week. The plans must cover all the essential benefits as outlined in ACA and deductible/OOP maxes must be what they are now, under the law.There are no subsidies or tax benefits to any business. Employee share will be a % of their salary and the % will increase the bigger the salary - so the business pays more for insuring their lowest paid workers and less for their higher paid employees. </p>
<p>Anyone who is not employed, for whatever reason, and not covered by a parent or spouses insurance,is automatically enrolled in Medicaid but can have the choice of Medicare if they are willing to pay the premium, etc. </p>
<p>All doctors and hospitals would be required to accept every insurance. </p>
<p>I’ve seen a number of pieces about state-by-state increases, LF, but until you specify what sources you consider impartial enough to discuss, I don’t see the point of posting them.</p>
<p>(And no, they’re not governmental - the feds don’t seem to know much of anything, including how many made their first premium payment. )</p>
<p>When you factor in various other adjustments to AGI that higher income families can use (such as IRA contributions), the cutoffs in terms of total household income are actually higher than those numbers already. </p>
<p>I have posted this before as I personally am at the cutoff level for a single taxpayer. There’s no “cliff” for me. There is a benefit in terms of a tax credit that I never got pre-ACA that never expected to qualify for post-ACA, but I might just qualify for if I am lucky, – with “lucky” defined as “make less money”. It’s equivalent to being “lucky” enough to qualify for a Pell grant -which my daughter could get in years #1 and #4 of college, but not years #2 and #3. It never occurred to me that the income which pushed our FAFSA EFC above the $5000 mark was the equivalent of falling off a cliff, nor do I see it as valuable to frame the failure to qualify for a different government benefit in those terms. </p>
<p>It is true that the cost differential for me between subsidized vs. not-subsidized is very steep – but my point is that I am looking at the premium tax credit as a potential benefit that I may or may not get, rather than a government entitlement that I may or may not lose. </p>
<p>I’d note that the tax code is full of all sorts of arbitrary cutoffs that have cost me – or threatened to cost me – a lot of money over the years. One year I got something of a windfall that almost put me in AMT territory, for example. I’m pretty sure that the difference in $$ at that time would have been well above the roughly $5K that the so-called “cliff” will cost me in premium dollars.</p>
<p>Without ACA I would still want to have insurance. The difference is that I would have to pay 100% of the premium, whatever it cost, without any hope of government support. The scary part is that would mean that if I sick enough to cause me to be unable to work for an extended time, I could be in a situation of losing insurance because of the inability to pay premiums. Now I wouldn’t face that problem – I would simply have to report a change of income to the exchange. </p>