Obamacare 5 years later. Crow, anyone?

[ponderingturtle]

God, what a perfect analogy. Thank you.


(Although Cadillac is making much more reliable vehicles of late. But calling it the BMW or Audi of health care systems just doesn't have the same zing.)

Sure, but it doesn't have the wonderful double meaning, because being called the Cadillac of this or that is a phrase some still use at least. And sure the Jaguar might be more accurate but loses the linguistic edge.

 

[Psi Baba]

If there is a bureaucratic foul-up that causes me to lose my insurance I have to pay huge fines that I can't afford. Since the fine is based on flat fee or a percentage of income, whichever is higher, I can't work extra hours to make the money to cover the fine without making the fine higher.

I can't work extra hours to make a bit of extra money or to oblige my client (I'm an independent contractor) without losing my insurance and having to pay huge fines that I can't afford.

If the legislature votes to get rid of the Medicaid expansion then I lose my insurance and I have to pay huge fines that I can't afford. Since the fine is based on flat fee or a percentage of income, whichever is higher, I can't work extra hours to make the money to cover the fine without making the fine higher.

If my client decides to give me a bonus without sufficient notice for me to be able to work fewer hours, I could end up making too much money that month and lose my health insurance and have to pay huge fines that I can't afford. Since the fine is based on flat fee or a percentage of income, whichever is higher, I can't work extra hours to make the money to cover the fine without making the fine higher.

I'm effectively locked into poverty with the threat of huge fines due to circumstances beyond my control constantly hanging over my head. That's what's stressing me out.

I've been wondering about these "huge fines" so I checked.

According to heathcare.gov:

The fee for not having coverage in 2015

If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:

2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
$325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.

For the 2% penalty to exceed the $325, one would have to earn more than about $26,500. What I don't understand is why you would lose your coverage if you make more money. From what you've said (being just over the cutoff for Medicaid), it doesn't sound like you're making very much to begin with. Did you choose a plan that you are eligible to keep only if you earn under a certain amount?

According to this site, the maximum earnings for Medicaid in Arizona, for a single individual is $11,170.

 

[CynicalSkeptic]

It's quite a bit of work to debunk each of these claims, especially without knowing specifics like CelticRose's # of dependents.

If there is a bureaucratic foul-up that causes me to lose my insurance I have to pay huge fines that I can't afford. Since the fine is based on flat fee or a percentage of income, whichever is higher, I can't work extra hours to make the money to cover the fine without making the fine higher.

Earlier in the thread CR also said:

I make just under the cutoff for Medicaid. If I work extra hours or get a bonus, I lose my health insurance. So, I have absolutely no incentive to work extra when there's extra work available; in fact, I have a very strong disincentive. I'd be surprised if I were the only one in this situation.

If you are single with no dependents, the cutoff for medicaid is 133% of federal poverty level and FPL as $15,281. If you have kids between 6-18 the cutoff is also 133% of FPL, and FPL for a family of 4 is $31,321
Sources(http://www.healthinsurance.org/arizona-medicaid/ http://obamacarefacts.com/federal-poverty-level/)

The fine for not carrying insurance is:For 2014, the penalty is the greater of a flat $95 per adult and $47.50 per child under age 18, up to a maximum of $285 per family, or 1 percent of the portion of your family's modified adjusted gross income that is more than the threshold for filing a tax return. That threshold is $10,150 for an individual, $13,050 for a head of household and $20,300 for a married couple filing jointly.


That's $51 (1% of 15281-10150) if single, so you'd pay the higher fee of $95
or 110 (1% of 31321-20300) for a family of 4, so you'd pay the higher fee of $285 (95 * 2 + 47.50 * 2). I used UNadjusted gross income, but adjusting down wouldn't matter, you'll still pay the flat fee.

Yes, it would suck to lose your insurance and have to pay a fee for it, but $100-$300 per year doesn't seem that significant. And yes, I understand the rates go up in the years to come.

I can't work extra hours to make a bit of extra money or to oblige my client (I'm an independent contractor) without losing my insurance and having to pay huge fines that I can't afford.

If you worked extra hours to put you over the max for receiving medicaid, and chose not to buy (subsidized) insurance, the fees would be the same as above unless you increased your income significantly.

If single, for an annual increase in income of $5000 you still would pay the flat rate of $110, if you increased it by $10000, the fee would go up to $149, and it's $50 for each $5000 income increase after that (and again, that's unadjusted income, but close enough).

If it's a family of 4, you would have to increase your income by $20,000 to be paying more than the flat rate of $285.

If the legislature votes to get rid of the Medicaid expansion then I lose my insurance and I have to pay huge fines that I can't afford. Since the fine is based on flat fee or a percentage of income, whichever is higher, I can't work extra hours to make the money to cover the fine without making the fine higher.

This is the same as the first argument. Your fee will be $110 or $285

If my client decides to give me a bonus without sufficient notice for me to be able to work fewer hours, I could end up making too much money that month and lose my health insurance and have to pay huge fines that I can't afford. Since the fine is based on flat fee or a percentage of income, whichever is higher, I can't work extra hours to make the money to cover the fine without making the fine higher.

This is the same as the 2nd argument. If medicaid tracks your income on a monthly basis (I don't know, but I assume medicaid would get those number from the IRS, and since you're an independent contractor, you probably file quarterly), it would be unfortunate to briefly lose your insurance and be fined for that because you made a little extra money.

I'm effectively locked into poverty with the threat of huge fines due to circumstances beyond my control constantly hanging over my head. That's what's stressing me out.

BS. If you have the ability to increase your income by more than a few hundred dollars there is no economic disincentive to do so purely based on the fine.

I'm not going to bother to determine rates for buying insurance at income levels slightly above the medicaid cutoff, but yes if you value insurance, there is an economic disincentive to making just slightly more than 133% of poverty level. If you can bump your income up by a few/several thousand that disincentive goes away. There is a small window (cost of the fine or cost of insurance) above the medicaid limit that is a bad place to be income-wise. Once you are above that, you are better off.

 

[CynicalSkeptic]

What I don't understand is why you would lose your coverage if you make more money. From what you've said (being just over the cutoff for Medicaid),

Just under, not just over. And I used the numbers for 2014, so I have different numbers than Psi Baba. The current fines are quite a bit higher, but my greater point still holds. If you can increase your income by enough to cover the fines, or cover the cost of insurance, there is no disincentive to staying below the medicaid cutoff.

 

[Emily's Cat]

I was never a burden on the system before Obamacare; now I am. The way Medicaid works is that the state (AZ in this case) pays premiums to an insurance company. Those premiums get paid whether I go to the doctor or not. I seldom go to the doctor, so that money just goes to enrich the insurance company rather than helping someone who actually needs it. It's a complete waste of taxpayer money.

If it's any consolation, that money does go to help other people, and doesn't just enrich the insurance company. The amounts that Medicaid pays for managed medicaid are based on the average cost of the people covered. They pay more for your enrollment than you actually spend in care... but they also pay much less than the person with ESRD actually spends. The funds are intended to balance out in aggregate. The insurance company doesn't just pocket the money sent on your behalf - it goes to paying the costs of other, sicker people for whom the payment is low.

Obamacare has been nothing but a huge source of stress to me, which can't be good for my health. I'm terrified every time I get something from Medicaid because I'm afraid that there's been some bureacratic foul-up that means my insurance has been cancelled. And our legislature is voting this summer on whether to take away the Medicaid expansion. And, it's not impossible that I could get a bonus out of the blue and make too much money.

Making too much money for Medicaid might not be as bad as you think. In many cases, the subsidy for insurance through the exchange is enough to allow the purchase of a Bronze plan for $0 premium. This isn't true in all locations, and most importantly it's not true for all ages. If you're young, then it's likely to cover only a portion of the premium, whereas if you're older, it's likely to cover all of it. It's far from a perfect solution.

It might be worth your time to contact the Navigators for your state exchange, and ask some questions about how it works. If nothing else, it might put your mind at ease and reduce some of your stress.

ACA is far from perfect - it's got some serious flaws. But it's better than nothing.

 

[Emily's Cat]

Failed Prediction #1: Americans won’t enroll in the ACA

In 2009 and 2010, it was widely assumed among Republicans that Democrats had fundamentally miscalculated public demand and consumers would show no real interest in signing up for coverage through the Affordable Care Act. Indeed, among some on the right, this was a foregone conclusion – Americans wouldn’t trust “Obamacare.”

We now know, of course, that the opposite is true and that millions of families have eagerly signed up for benefits through the ACA.

Every time I read something like this, it makes me furious. Yes, people have signed up for health insurance; if we don't, we have to pay huge fines. Saying that people have "eagerly signed up" when they've been forced to is like celebrating a dictator's landslide election victory.

It irritates me for completely different reasons .

It bugs me, because there's some conflation going on. All of the discussions about Americans not signing up for ACA quickly were referencing the Individual Market Exchange. But the numbers quoted as a counter to that include the Medicaid Expansion population as well. It's a bit of bait and switch to me.

Doesn't make it untrue... just makes it less of a "failed prediction" than proponents want it to be.

 

[Emily's Cat]

If they said that I believe they are trying to pull the wool over your eyes. That percentage seems way to high. Although I am having trouble finding data to back up either my belief or their statement.

Depends entirely on the state environment, the average health of people, and the propensity for that company to attract adverse selection. It might not be common, but it's not out of the realm of probability.

One of the states we operate in has a very small Individual Market - most of the people who live there work for large employers, and only a very few purchase insurance for themselves. The state also had a State-run High Risk Pool. People who were denied coverage through standard health underwriting became part of that pool, which was funded by payroll taxes. When it was spread over all the working bodies in the state, it wasn't all that much, something on the order of $2 per month per person.

With the advent of ACA, the state disbanded the High Risk Pool. All of those people became part of the Individual market, because insurers could no longer deny them coverage. The problem was that the High Risk Pool had about a tenth the number of people as the prior Individual Market... but those people had costs that were on the order of 8 times as high on average.

The migration of the High Risk Pool all by itself accounted for more than a 60% increase in the premiums in the Individual Market, across the board.

 

[Emily's Cat]

Unfortunately the one proven model that is better than the current ACA model is the single payer system.

Actually, there are several models that work better than ACA. Not all of them are single payer, and some of them depend on how you define "payer".

That said, ACA is still better than what we had before.

 

[Emily's Cat]

Yes, it would suck to lose your insurance and have to pay a fee for it, but $100-$300 per year doesn't seem that significant.

If you've got an extra few hundred laying around, then it's no big deal. If you're living paycheck to paycheck, as someone on Medicaid is likely to be doing, it can be a pretty serious fine.

Back when I was young, we moved, and I ended up owing taxes instead of getting a meager refund. The bill was a whopping $250... but that meant that we couldn't supplement our diet of Ramen with any actual meat for a couple of months.

BS. If you have the ability to increase your income by more than a few hundred dollars there is no economic disincentive to do so purely based on the fine.

I'm not going to bother to determine rates for buying insurance at income levels slightly above the medicaid cutoff, but yes if you value insurance, there is an economic disincentive to making just slightly more than 133% of poverty level. If you can bump your income up by a few/several thousand that disincentive goes away. There is a small window (cost of the fine or cost of insurance) above the medicaid limit that is a bad place to be income-wise. Once you are above that, you are better off.

That's not absolutely true. Depending on the person's age and the average premiums for that state, the cost of insurance even with a subsidy can be significantly higher than the fine.

This is one of those cases where if you look at "average" experience, everything seems peachy. Then when you look at the variance involved, and see the experience on the tails of the distribution, it can paint quite a different story.

 

[CynicalSkeptic]

That's not absolutely true. Depending on the person's age and the average premiums for that state, the cost of insurance even with a subsidy can be significantly higher than the fine.

CelticRose was only complaining about the "Huge fines", not the cost to purchase through the exchange. We don't know anywhere near enough about her(???) situation to determine costs to purchase insurance.

If you've got an extra few hundred laying around, then it's no big deal. If you're living paycheck to paycheck, as someone on Medicaid is likely to be doing, it can be a pretty serious fine.

Since CR is aware of the fine he/she can plan ahead and set aside the $20-$50 per month to cover the costs of the fine. In fact, shouldn't that be included as part of the estimated taxes when doing quarterly filing?

 

[Emily's Cat]

Since CR is aware of the fine he/she can plan ahead and set aside the $20-$50 per month to cover the costs of the fine. In fact, shouldn't that be included as part of the estimated taxes when doing quarterly filing?

Sure. Assuming that CR has an extra $20 to $50 per month to set aside in the first place.

Look - I've been there. I spent years rubbing two pennies together hoping they'd somehow mate and produce a third. I lived for a good long time on Ramen with some cheap ground beef added, and nothing else in the way of nutrition. There was a point where about every 3 months we had enough extra to get one pepperoni pizza from Little Caesars - that was big spending for us.

The assumption that $20 to $50 a month is no big deal, and everyone should be able to plan for that... is well... naive reflection of privilege. Not saying it's a bad thing - I don't attach any moral judgment to the term, and it doesn't imply anything about merit. It's simply that we all take our experiences as the baseline from which we assume normality. If you grew up in a household where $20 a month was easily doable, then the idea that that is prohibitively expensive to someone seems absurd.

What I'm trying to say is that you may not want to deride CR for complaining about the fine as huge. To you it seems paltry. But you're not in her situation, and just because $300 seems far from "huge" in your experience doesn't mean that it's small to her.

ETA: For comparison, my spouse's family was more affluent than mine when he grew up. Even after having spent those few years pinching every cent with me, he still views the world through the privilege of his childhood. He regularly refers to spending $1000 in a month as "no big deal". To him, $20 has no more meaning that $1. To me, there's a world of difference between the two, and likely always will be.

 

[CelticRose]

Sure. Assuming that CR has an extra $20 to $50 per month to set aside in the first place.

Look - I've been there. I spent years rubbing two pennies together hoping they'd somehow mate and produce a third. I lived for a good long time on Ramen with some cheap ground beef added, and nothing else in the way of nutrition. There was a point where about every 3 months we had enough extra to get one pepperoni pizza from Little Caesars - that was big spending for us.

The assumption that $20 to $50 a month is no big deal, and everyone should be able to plan for that... is well... naive reflection of privilege. Not saying it's a bad thing - I don't attach any moral judgment to the term, and it doesn't imply anything about merit. It's simply that we all take our experiences as the baseline from which we assume normality. If you grew up in a household where $20 a month was easily doable, then the idea that that is prohibitively expensive to someone seems absurd.

What I'm trying to say is that you may not want to deride CR for complaining about the fine as huge. To you it seems paltry. But you're not in her situation, and just because $300 seems far from "huge" in your experience doesn't mean that it's small to her.

ETA: For comparison, my spouse's family was more affluent than mine when he grew up. Even after having spent those few years pinching every cent with me, he still views the world through the privilege of his childhood. He regularly refers to spending $1000 in a month as "no big deal". To him, $20 has no more meaning that $1. To me, there's a world of difference between the two, and likely always will be.

Thank you for this. It's nice to see that someone understands.

*sigh*

I should have known better than to participate in a thread in Politics; I certainly won't make that mistake again. I had forgotten that this section was more about finding one person in the thread to pick on than actually discussing a topic like adults. I thought that I would contribute to the discussion by providing a different perspective, and I just got dogpiled on by a bunch of people who obviously have no clue what it's like to be poor and assume that everybody wants and needs the same things that they do. I don't have the time or energy to defend the realities of my life situation, nor do I feel I should have to.

I'm outta this thread, and I'll stick to the friendlier parts of the forum from now on.

 

[thaiboxerken]

That's right, CR.. you are the only poor person in the forum and that's why you have a unique opinion on the ACA......

 

[Elf Grinder 3000]

The conservatives won't admit that the ACA is a large step forward from what we had before. They still claim it kills jobs despite the fact that it doesn't.

Does 2 Trillion in additional spending and the taxes to pay for it hurt job growth?

From what I've heard Canada and the UK have a horrible health care system. Its going to be a long process towards the abyss.

 

[slyjoe]

Does 2 Trillion in additional spending and the taxes to pay for it hurt job growth?

From what I've heard Canada and the UK have a horrible health care system. Its going to be a long process towards the abyss.

Maybe read something other than right wing talking points. See post 80.

 

[Shalamar]

Does 2 Trillion in additional spending and the taxes to pay for it hurt job growth?

From what I've heard Canada and the UK have a horrible health care system. Its going to be a long process towards the abyss.

You hear wrong.

 

[thaiboxerken]

Does 2 Trillion in additional spending and the taxes to pay for it hurt job growth?

From what I've heard Canada and the UK have a horrible health care system. Its going to be a long process towards the abyss.

Facts are what we use to make our points in this forum. What you've asserted is fiction and lies.

 

[Border Reiver]

From what I've heard Canada and the UK have a horrible health care system. Its going to be a long process towards the abyss.

Where are you hearing this? And how are you defining "horrible"?

 

[The Don]

Does 2 Trillion in additional spending and the taxes to pay for it hurt job growth?

From what I've heard Canada and the UK have a horrible health care system. Its going to be a long process towards the abyss.

As long as "horrible" means "more effective and around half the price" then you're right, the NHS is horrible compared to the U.S. healthcare system.

In fact I shall use that definition of "horrible" henceforth.

"My compliments to the chef, the meal was horrible and as a consequence my tip will be generous"

 

[Francesca R]

I hate the mandatory insurance part of Obamacare.

You will never get coverage for pre-existing conditions without some measure of mandatory insurance coverage. This could either be a tax or mandatory insurance, but at some point you need to pay for the free riders who only sign up for insurance when they are sick and need expensive care. The alternative is to let insurance companies weed these people out with pre-existing condition clauses, but this ends up creating an expensive administrative burden and making people fight for insurance coverage they are legitimately eligible for.

Completely correct.