Healthcare Changes : Restarting the discussion with a few more ground rules.

Agree Gravity was excellent. Sometimes the masses are right, a lot of the time actuallyimo. Hated bullocks character in the beginning scenes. As the movie progressed she became magnificentimo. Little italian for spice!!

Peter will do that. This is the one where Sandra Bullock is lost in space?

For a fee...

sure, if you wait 12-18 months on new technology the prices drop significantly.

Thanks Tony.

That's what I meant any treatments required by the clinical trial that would not otherwise be covered by insurance since they are not yet standards of practice, not the complete cost of the clinical trial.

LupronJim

I get motion sick when watch 3D movies on the big screen. If I got really badly sick because of that and was on an ACA plan would the treatment be covered?

Of course, here in California we're going to ban 3D movies soon because some people get sick while watching them so I might not have to worry about it for too long.

Well, that's about as much political controversy as I can stir up in a day...
:)
Andrew

I couldn't sit through any movie with Sandra But-tocks in it, lol. Can't stand her.

Wanted to see the one about the container ship captain, think played by Tom Hanks, that got captured by the Somali pirates.

And wanted to see the new Formula 1 movie, but missed it. Daughter said it was the best racing movie of all times, including my long fave, "Le Mans" with Steve McQueen.

Last movie I went and saw was "Insidious 2", love that series.

RCS,
It may depend on which is more psychologically distressing?

Tony

now we're bashing Sandra Bullock? Nobody here saw "The Heat"?

Back to DavidG's issue with the employee that was terminated and can't afford COBRA. As I understand, for the balance of 2013 COBRA is probably all she can get. If she applies for individual coverage for the balance of the year, the pre-existing conditions will be an issue. She can look into her state's high risk pool, but expect it to be as expensive as COBRA, and not all states have a pool. ACA coverage and rules apply 1-1-2014. So if she is going without COBRA she has the next 60 days without coverage. Starting 1-1-2014 she can buy any of the plans on the exchange or off the exchange and based on her expected 2014 income (which includes unemployment benefits) she will either get no subsidy, some subsidy, or if her income is less than 133% of the poverty level she will be put on Medicaid. Income is calculated based on the family income, not just hers.

Under COBRA she basically has 60 days from termination to elect it and begin premium payments. If she needs treatment during this period she is covered as she has been on the group because she still is on the group, even though she hasn't paid the premium yet. I think the best for her is to see if she needs the coverage in the 60 day period for something major. If she needs treatment that costs less than the COBRA premium she pays for the treatment. If it costs more than the COBRA premium she finds some way to pay the premium.

Then, if she expects her family income to be low enough for the subsidy in 2014, she goes to the exchange and signs up before December 15, 2013 so her coverage is effective 1-1-2014. If she won't get a subsidy she talks to an insurance broker or EHealthinsurance and buys an individual plan directly. The only advantage to the exchange is that is where you go to get a subsidy or Medicaid.

Too bad the employer couldn't delay her termination a few days so that 60 days of potentially free COBRA would bridge the gap to the coverage effective in 2014.

An important caveat, I am going from operational memory on this stuff. While I have to work with health insurance and government benefits in my practice I am not an expert. Please check my information and not take it as gospel. I appologize in advance for any inaccuracies and wish her the best.

Jack

I would imagine that the potential employer of this potential person is concerned about setting a precedent. That said, who knows, maybe they are trying to arrange something.

I ran a test and with an annual family income of 48K the person would qualify for subsidies and be approximately $3K out of pocket per year. If the Kaiser calculator is correct, that sure beats Cobra for a theoretical individual in this theoretical situation.

Jack,

Great write up. Thanks for putting it together.

John, in the first situation I think it depends how the insurance is provided. If it is individually owned, there is no issue as the person would merely buy on the exchange and get the subsidy, hopefully getting comparable coverage. If the coverage is employer sponsored, the employer will have to adjust the employee premium so it meets the 9.5% threshold, or the employer will eventually pay a $3,000 fine under the employer mandate. The real gap is where the employee cost is within the 9.5% rule but the dependent care is either high or the employer cancels the dependent care option as so many have. The whole point of the exchange is to provide a subsidy to individuals who are not subsidized by their employer paying part of the cost. The exchanges are not needed to enhance the buying experience as there are already many ways to do that. There were other ways to get the subsidies without building the exchanges, but congress chose this method.

With your second point, as I understand it, the non-subsidized don't need to buy through the exchange to count among the 7.5 million healthy young and presumably non-claimers, they just need to buy the insurance. Remember the premiums don't go to the government, they go to the insurance companies no matter how the purchase is made, whether through the exchanges, directly by the insured, or through the employer or union. The need for the 7.5 million to buy is to keep the insurance companies solvent and the premium rates at the current levels. The assumption is that there are 7.5 million young healthy and poor people that will buy heavily subsidized insurance through the exchange. The concern is that many of these won't be subsidized enough to but and will pay the modest mandate tax instead. The dreaded insurance company death spiral occurs when too few young healthys buy and too many older sickies buy and use the insurance driving the claims costs up. Then the rates go up significantly so that fewer buy at all leaving the insurance company in an insolvent position. If the insurance companies fail then the PPACA collapses. If there is no coverage to buy how is the employer and employee mandate carried out? Real problems.

To the third point, as you point out the tax may prove to be uncollectible. As you mention, failure to pay the tax will not result in criminal action or collection actions in the way failing to pay federal income tax can. I understand the only way the IRS can collect the individual mandate tax is through the excess taxes one pays through the year in withholding and/or estimated quarterly payments that actually result in a tax refund. The PPACA tax is then taken from the refund otherwise due. So if a person adjusts the estimated payments and/or withholdings to produce no refund then the IRS has nothing to hold onto. I haven't read the regulations, but I have to guess that the IRS can aggregate the tax year by year, add interest and apply it against refunds in the future. If it turns out that the tax is uncollectible and the PPACA costs to the government become too great then it would be up to congress to change the law to make the tax collectible.