Affordable Care Act- The Non-political Thread

[Pennilenko]

Before this thread goes the wrong way, I wanted to thank Abagadro for taking the time to share information with those of us that had trouble understanding the ACA. By us, I mean mostly me, because I didn't understand any of it.

[Lakov_Sanite]

All this thread makes me think is I need to start asking for job advice and get out from under the poverty line.

[Surlyboi]

I forgot we had so many wealthy people on f13.

I didnt. Donation drive is still below goal.

Weren't we over goal last year?

[Teleku]

That was to fund the servers.  This is to fund Schilds coke habit redesigning F13.

And has already been noted, the 1% here might have donated more if Schild hadn't so effectivly convinced a large amount of people to drop half a grand on a vaporware fake internet card game shortly before asking for donations.  

[Numtini]

All this thread makes me think is I need to start asking for job advice and get out from under the poverty line.

FWIW, most of my friends who are in the dirt poor young person category just get insurance--in both cases I can think of they were also signed up when they went to the emergency room right on the spot. That's the medicaid expansion part. The subsidized plans are supposed to be for "middle class" people who may not be able to afford the entire thing, but if you can't afford any of it, you don't get saddled with a fine. Again, this is Mass where the state government was dedicated to making the plan work, not scuttling it YMMV. But for what it is, it's really worked out well in Mass. It hasn't seemed to turn into any sort of burden.

[luckton]

The burden will be on the healthcare industry itself when the countless masses all of a sudden start showing up to have their health problems addressed because they can't be barred at the door anymore. 

But that's a topic for the next presidency 

[Numtini]

The burden will be on the healthcare industry itself when the countless masses all of a sudden start showing up to have their health problems addressed because they can't be barred at the door anymore. 

Again, we've had the system for several years. It really has been a non-event. It covers more people, but it's not perfect and people still end up in bankruptcy for medical problems.

[schild]

That was to fund the servers.  This is to fund Schilds coke habit redesigning F13.

And has already been noted, the 1% here might have donated more if Schild hadn't so effectivly convinced a large amount of people to drop half a grand on a vaporware fake internet card game shortly before asking for donations.   

The timing of Hex was... depressing.

Weren't we over goal last year?

Yup. Hence why we do not need a donation drive for servers this year. They're paid through next September.

[HaemishM]

My fucking pissant backwards state is trying everything they can think of to not set up an exchange, so finding out any goddamn information on our particular situation is MADDENING. I think we'll end up with a federal exchange (which I'm actually ok with since it means these backwoods inbred wookiefuckers don't do everything they can to scuttle it) but my biggest problem is finding out any real information on the subsidies we'll get for buying on the exchange. According to my tax preparer, we should get enough that it'll be totally paid for by tax subsidies, but who the fuck knows? Certainly not the assholes in charge of setting the goddamn thing up.

[Pennilenko]

It could be just me not knowing where to look, but information here in Florida has been extremely scarce if not hostile when calling around for information.

[Polysorbate80]

Generally speaking, will signing up for ACA be cheaper than the healthcare provided by my work?  I'm single and paying $80 a month on medical alone. 

Also, what's to stop my employer from dropping our health care? 

If you have "affordable" care from your employer (which is defined as less than 9.5 percent of your income) you most likely won't be eligible for the exchange.

As stated above, the employer gets hammered by penalties. All employers over 50 employees have to offer affordable coverage to their employees or get fined (it is more than 2k a year last I heard. The number I've seen thrown around is 250 per month).

They complicate it even more than that.  If you have more than 50 full time equivalent (actuall full time, or part timers adding up) then you qualify for penalties if you don't offer insurance.  However, you only pay penalties on actual full time employees, part timers don't count for that calculation, and you get to not count the first 30 or so full-timers.

Then, there's two options on the penalty.  The easy to understand one is just $2000/year (in monthly installments) per full time employee, flat rate, with upward adjustments probably every year.  The other I can't remember the details, it's something like $3000/year per employee but some employees may not count.

As an employer, I'd rather offer insurance but I'm going to wind up paying the penalties instead.  We've looked into it, but the rates are just too high.  Hopefully if our state is kicked in the ass hard enough to stop dragging its feet on the exchanges, the rates will wind up at a reasonable level rather than the obscene shit we've been quoted.

[Hammond]

So the part I do not understand is if a employer pays the penalty fee rather than providing insurance for the employees. Do the employees by default get discounted / free insurance from the state / federal exchange? Or is it the case where both end up paying? Thankfully my employer is paying for my insurance but I know a few people that are going to fall into the above situation.

[Numtini]

As an employer, I'd rather offer insurance but I'm going to wind up paying the penalties instead.  We've looked into it, but the rates are just too high.  Hopefully if our state is kicked in the ass hard enough to stop dragging its feet on the exchanges, the rates will wind up at a reasonable level rather than the obscene shit we've been quoted.

If they don't create an exchange, one will be created by the feds. That's gotten delayed because so many states fiddled and diddled about deciding whether or not they were going to do their own.

Unfortunately, the small business aspect of the federal exchange seems to be something that's going to be partially delayed. As I understand it, there will be a variety of options, but you will need to choose one plan for all your employees, where the eventual aim of the small business exchange is you can offer a variety of plans for the employees to choose from on an individual basis. There's also tax credits up to 50% of the employer part of the cost.

So the part I do not understand is if a employer pays the penalty fee rather than providing insurance for the employees. Do the employees by default get discounted / free insurance from the state / federal exchange? Or is it the case where both end up paying? Thankfully my employer is paying for my insurance but I know a few people that are going to fall into the above situation.

Such a person can buy insurance in the exchange as an individual and they'll get whatever subsidies their income and family status qualifies you for. If they don't choose to do so, they are subject to the individual penalty. So yes, both would pay the penalty.

[Hammond]

Thanks,

I figured it might be the case but I have not seen anything explicitly saying that.

[Yegolev]

Current plans are to review options, but a corporate split is definitely on the table so as to remain under the 50-employee limit.  The real question would be if the larger corp could fit under 50.

[Quinton]

I clearly live in a Silicon Valley / Tech Industry bubble, because this talk of companies opting to pay penalties instead of insuring people immediately makes me think "who in the world would accept a job offer from a company that didn't provide health insurance?" 

[01101010]

I clearly live in a Silicon Valley / Tech Industry bubble, because this talk of companies opting to pay penalties instead of insuring people immediately makes me think "who in the world would accept a job offer from a company that didn't provide health insurance?" 

People who have unemployed for a long time and just want some kind of income?

[Yegolev]

Basically 99% of the employees of my in-law's company.  They are the sort of people that opt for short-term wins.  The company had health insurance in the past, but the employees generally preferred to opt out and keep the cash so the program was discontinued.  My wife uses my insurance, and the rest of the office workers are self-insured.

[Quinton]

To be clear, I totally understand that insurance coverage is not a given and that the vast majority people don't have the luxury of picking and choosing jobs (like I said, I'm clearly living in a bubble here), but just the idea that insurance would not be part of the standard package seems kinda crazy to me -- I'm not sure how a tech startup out here could survive and manage to hire people if they didn't offer insurance -- I've worked for tiny companies (smaller than 20 people) through pretty enormous ones (30k+ on staff) and that was never something up for debate.

I guess the "why the hell haven't we fixed this yet" debate is more politics forum territory.

 

[Numtini]

Wikipedia'ing it quickly, 39% of workers aren't covered by employer provided insurance.

[Ghambit]

It boils down to price differences between large company-wide groups and individual insurance.  As the spread gets more and more negligible, there becomes less and less a reason to use/have company-insurance.  This ACA is the 1st step towards getting rid of bulk rates altogether I assume... and hope.  

Seriously, why should "x" person live healthier because he's got an affordable group policy as opposed to "y" person that doesn't?  The whole ideal needs to go away.

[Trippy]

To be clear, I totally understand that insurance coverage is not a given and that the vast majority people don't have the luxury of picking and choosing jobs (like I said, I'm clearly living in a bubble here), but just the idea that insurance would not be part of the standard package seems kinda crazy to me -- I'm not sure how a tech startup out here could survive and manage to hire people if they didn't offer insurance -- I've worked for tiny companies (smaller than 20 people) through pretty enormous ones (30k+ on staff) and that was never something up for debate.

I guess the "why the hell haven't we fixed this yet" debate is more politics forum territory.

Silicon Valley has had a long history of generous employee benefits. HP was probably the first but there were other companies known for their benefits as well like Rolm and Tandem. Lockheed, which at one point was the largest employer in the valley, also had amazing benefits for employees. Things sort of stayed at that level for a while and then Google came along and raised things to a whole other level. Other companies here still can't compare to what Google provides its employees though some are trying to close the gap.

[HaemishM]

That was the idea behind the exchanges - they'd basically be a massive pool of those who just didn't happen to be a part of any of the other pools available which were usually available only because businesses wanted "offers health insurance" as a reason to want to work there.

[Ghambit]

Thing is, that's not really the business' fault.  That's the fault of unregulated free enterprise.  Broker sits down with HR and salivates over possibly getting commission on 100 employees signing up for "x" plan, offers them steep discounts as to what they'd offer joe shmo individual in his cubicle (with maybe a free trip to Tahiti for the HR gal), then HR passes that info. onto joe shmo job applicant.  Govt. comes in and is all like "oh, that's cool" let's now require businesses to do that so we can all be happy with our perceived discounts!  Now the 30%+ price gap shoots to 35% and so forth.  And upward price pressures continue.

Meanwhile there a like five brokers (including HR itself) between the applicant and the doctor, all making money off your plan.   

[Polysorbate80]

To be clear, I totally understand that insurance coverage is not a given and that the vast majority people don't have the luxury of picking and choosing jobs (like I said, I'm clearly living in a bubble here), but just the idea that insurance would not be part of the standard package seems kinda crazy to me -- I'm not sure how a tech startup out here could survive and manage to hire people if they didn't offer insurance -- I've worked for tiny companies (smaller than 20 people) through pretty enormous ones (30k+ on staff) and that was never something up for debate.

I guess the "why the hell haven't we fixed this yet" debate is more politics forum territory.

We provide services for developmentally disabled kids & adults, and get our reimbursement from the state for 90% of everything we do.   Medicaid doesn't reimburse us enough to pay more than $200-250/month in premiums before we lose money on the deal, and it was only after the state got sued last year that they started reimbursing at a rate high enough to allow for that.

Right now, some of those funds go to employees to help defray insurance costs if they have their own insurance, the rest is in a pool (and getting taxed) while we figure out where to go from here.  If the costs get down into that $250ish range, then it's insurance time for all.  As it stands, we've got employees who would cost anywhere from $300 to $1000 a month in premiums.

Edit to add:  the irony is thick on this one; the people we serve all have coverage.

[Ingmar]

Rolm

 

I worked for KenO, he was such an awesome guy.

[Trippy]

Man you are old (in Silicon Valley years)

[Kitsune]

There are so many variables and wild theories flying around that I frankly have not the slightest clue what the end result is going to be for our medical system.  On the one hand, I hate the everloving fuck out of insurance companies.  On the other, anything done by the government is riddled with idiocy and corruption.  While my hope is that this leads to a new, more reasonably priced healthcare system where hospitals don't charge $90 for aspirin, I'm having a hard time working up much optimism.  Judging from Abagadro's chart thing, my premium should decrease somewhat, but that still leaves the question about just what quality service I'd be getting under the federally mandated price plan.  I managed to get screwed badly last year by picking a 1500 deductible/30% copay plan and developing a kidney stone the very next month; got stuck with a $3000 bill that I'm still paying for the treatment.

[HaemishM]

but that still leaves the question about just what quality service I'd be getting under the federally mandated price plan

Since the federally mandated price plan is administered and controlled by a private insurance company, you'll likely get the same shitty HMO style health insurance service you would have gotten before this law was passed, only they can't cancel your policy when you get sick or deny you coverage because you are overweight or have some pre-existing condition.

[ghost]

but that still leaves the question about just what quality service I'd be getting under the federally mandated price plan

Since the federally mandated price plan is administered and controlled by a private insurance company, you'll likely get the same shitty HMO style health insurance service you would have gotten before this law was passed, only they can't cancel your policy when you get sick or deny you coverage because you are overweight or have some pre-existing condition.

But they can certainly charge you 2 or 3 times as much as before.   

[Numtini]

The plans offered in the exchange have to meet certain requirements and are basically exactly the same plans from the same insurance companies that you'd get from an employer.

[Ghambit]

The big thing with me is if I'll be able to hop onto plans put together by independent unions/groups in other states, such as the big one up in NYC that single-mom started (I forgot the name of it).  Under current laws I'm wedded to my state's rules, which is to fuck over labor as much as possible especially if you're self-employed.  With ACA, will I be able to latch onto these big self-insured groups??

[HaemishM]

No, I think you still have to buy it in the state you live in. I don't think you are allowed to venue shop.

[ghost]

The plans offered in the exchange have to meet certain requirements and are basically exactly the same plans from the same insurance companies that you'd get from an employer.

This is true, but it's been pretty commonplace to see those premiums and deductibles rising as well.  Some of my staff who have policies with their husbands' work have seen their deductibles and monthly fee rise by 50-100%.

[Ingmar]

Man you are old (in Silicon Valley years)

Well I didn't work for him at ROLM. Although, I do have a certification lying around somewhere in my office to support ROLM phone switches.