Budget Fight: Why Don't The Gop De-Fund Medicare / Social Security?

[twa]

if you go to the site you can get the official numbers for each state, no more he said/she said

 

http://www.webmd.com/health-insurance/state-marketplace-map

 

cool...people in Wyoming are like AAACCCCKK 

 

http://www.bloomberg.com/infographics/2013-09-25/healthcare-premiums-by-state-highest-to-lowest.html

[Bliz]

  . 

 

Right now, every level of the healthcare industry seeks to pad their invoices and health care for businesses is such an uncontrolled cost. If the business employs more than 49 people, then it can't participate in the exchanges anyway. BUT BUT the cost of healthcare goes up? Well, the cost of healthcare goes up and up each year. 

 

 

That's not entirely accurate.  Who is a "large" business is different for the exchange than it is for the employer mandate.  The federal exchange is available to businesses with 100 or fewer employees.  States that have set up their own exchanges may choose to restrict it to businesses with 50 or fewer, but only the first few years.  Pre-delay of the employer mandate, the plan was for the exchanges to open to employers with 100+ employees in 2017.

 

 

 

Asbury,

 

Go talk to the uninsured in your parish.  Tell them the joy they get on Oct 1 to pay $300 a month for health insurance plus a max out of pocket around $6000 - $13000 a year.  Let them know how great it is.  Let me know their response.  Make sure you tell them they get a free doctors visit each year for preventative health plus free birth control, and whatever else they get "free".  Let me know their reaction to this deal.

 

 

 

What you wrote doesn't account for tax credits.  Under the current poverty level designation, individuals with incomes ranging from $11,490 to $45,960 and families with incomes ranging from $23,550 to $94,200 for a family of four are eligible for the tax credit. The amount of the tax credit depends on income and the premium paid.

 

With the assistance of those credits, the actual limits on the cost of premiums range as low as 2% of income, for those with income up to 133% of the federal poverty level. In 2013, 133% of the FPL was $15,282 for an individual, and $31,322 for a family of four.   2% of that is $305 or $625, respectively...per YEAR.

 

Asbury, ask them how'd they feel about paying $25/month for health insurance.

 

 

 

[Bliz]

Asbury,

 

Go talk to the uninsured in your parish.  Tell them the joy they get on Oct 1 to pay $300 a month for health insurance plus a max out of pocket around $6000 - $13000 a year.  Let them know how great it is.  Let me know their response.  Make sure you tell them they get a free doctors visit each year for preventative health plus free birth control, and whatever else they get "free".  Let me know their reaction to this deal.

 

 

 

What you wrote doesn't account for tax credits.  Under the current poverty level designation, individuals with incomes ranging from $11,490 to $45,960 and families with incomes ranging from $23,550 to $94,200 for a family of four are eligible for the tax credit. The amount of the tax credit depends on income and the premium paid.

 

With the assistance of those credits, the actual limits on the cost of premiums range as low as 2% of income, for those with income up to 133% of the federal poverty level. In 2013, 133% of the FPL was $15,282 for an individual, and $31,322 for a family of four.   2% of that is $305 or $625, respectively...per YEAR.

 

Asbury, ask them how'd they feel about paying $25/month for health insurance.

 

 

 

 

More on the numbers.  Here's a link to the plans being offered in Rhode Island, which I link to because it's one of the only states I know of that actually have all of the details and costs of the available plans posted.  http://www.healthsourceri.com/wp-content/uploads/2013/08/HealthSourceRI-Individual-Plans-all-info-FINAL-08202013.pdf

 

For 45 year olds, there are 3 plans cheaper than $300/month.  For 21 year olds, none of the 12 plans costs $300/month.  And 4 of them are under $200/month.  And again, that's before any tax credits.

[twa]

$25 a month sounds great to me,I will believe it when I see it

[Elessar78]

Just pointing out a few things.

chip says $300/month. You respond with $92, biweekly.

I will observe that, on a biweekly plan, then twice a year there will be a "three payday month".

So, this may simply be a case of this being one of those Republican style "well, it's kinda true, sometimes, in the right situation, if you cherry pick just right, and if you put in a few disclaimer words that I intentionally left out, to make it sound like I was saying something else" kind of thing, which passes for truth in the modern Republican meme generator.

----------

I will also observe that, when I read your numbers, what I see is that a family of four costs a third as much as insuring one person?

Sorry, there was supposed to be a 6 on the end of that number. $346 biweekly. I was typing it at 4:30 AM this morning. 

 

I responded in biweekly numbers because if you're regularly employed, that's the number one sees being taken out of your paycheck. 

 

Depending on income, subsidies are available to bring the cost of premiums down. 

[chipwhich]

$25 a month sounds great to me,I will believe it when I see it

 

Even if it was $25 a month with tax credits, that doesn't take into account the max you could pay out of pocket for the year which isn't tax free unless you have an H.S.A plan.  The devil is in the details.

[Wrong Direction]

More on the numbers.  Here's a link to the plans being offered in Rhode Island, which I link to because it's one of the only states I know of that actually have all of the details and costs of the available plans posted.  http://www.healthsourceri.com/wp-content/uploads/2013/08/HealthSourceRI-Individual-Plans-all-info-FINAL-08202013.pdf

 

For 45 year olds, there are 3 plans cheaper than $300/month.  For 21 year olds, none of the 12 plans costs $300/month.  And 4 of them are under $200/month.  And again, that's before any tax credits.

 

Scroll down that file and see the deductible. The cheapest one is $5,000 for those "cheap" plans.

 

So you've got a premium of $150/month and another ~$425/month if you want to cover your deductible. This is where people will react.

 

The president clearly wants to focus on cheapest premiums.  That's the # that is most positive for him. He also wants to focus on subsidies. However, your first dollar of coverage doesn't start until you've already spent $6,800 out of pocket.

 

Now...one could argue that this is fine. It's catostrophic coverage, which is really what people need (if not what they want). On the other hand, acting like this is cheap just won't work when the numbers are out.

[Tulane Skins Fan]

So insurance companies don't adjust payment to incent cheaper products and services that are within clinical guidelines? I think you aren't familiar with payment schemes that have been in place for years.

 

 

Politicians absolutely set the rules behind pricing. They just direct the bureaucrats to do the math. Once the math was done once, every CPI price update made by Congress was a pricing update. Congress has power over pricing and reimbursement for ever part of Medicare.

 

You can only say Medicare pays below Market rates if you don't think the $600+ billion Medicare pays every year is somehow not part of the marketplace. Medicare sets the market. 

 

 

This is already the case. Medicare is already the most heavily lobbied government program. 

 

Honestly, pretty much none of this is reality.  There's no arguing.

 

I talk to insurance companies, health insurance companies, every day.  I just got off the phone with one.  I look at their bills, what is paid, and what is negotiated, and what is charged.  I work with Medicare almost every day.  

 

You are not right on the facts of how this works.  

[Larry]

Even if it was $25 a month with tax credits, that doesn't take into account the max you could pay out of pocket for the year which isn't tax free unless you have an H.S.A plan.  The devil is in the details.

 

1)  Really?  We've eliminated the health care expense tax deduction? 

 

I'm amazed that hasn't made the news. 

 

2)  What's the maximum out of pocket if you don't have insurance? 

 

(WD, you can feel free to chime in on this, too.  Since y'all seem to think that listing the maximum amount that people can spend, under various plans, is the fair way to compare.) 

[AsburySkinsFan]

Asbury,

 

Go talk to the uninsured in your parish. 

Why?

I'm uninsured, and I don't buy the Faux News/GOP lies about huge monthly payments.

That said, I argued for a public option but the GOP hated that idea because that's socialism.

[chipwhich]

1)  Really?  We've eliminated the health care expense tax deduction? 

 

I'm amazed that hasn't made the news. 

 

2)  What's the maximum out of pocket if you don't have insurance? 

 

(WD, you can feel free to chime in on this, too.  Since y'all seem to think that listing the maximum amount that people can spend, under various plans, is the fair way to compare.) 

 

1)  No, but the numbers are out now so you Larry can figure out what the true cost is.

 

Just for a topic point, which I realize has no nationwide value just a point to start.  My employees had a high deductible plan last year of $2500.  About 80% of all of my employees used their entire deductible.  About 10% used the entire deductible in the first three months.  So a plan with a $5,000 deductible, if you actually use the insurance, could gobble up quickly.  That's out of pocket funds.  As another baseline, the 10% who used the deductible were typically highly prescribed people with drugs that weren't generic.

 

2)  I don't know, I assume they avoided the doctor.  Would love to know.

 

Bottom line, what was needed was a single payer system, what we got is a tax on the poor.

 

I do have family members without insurance, and they are happy that way.  Heck even our own ladyskinzfan I believe mention she avoids the insurance scam.

Why?

I'm uninsured, and I don't buy the Faux News/GOP lies about huge monthly payments.

That said, I argued for a public option but the GOP hated that idea because that's socialism.

 

Well that's some real hardy har talking points.

Meanwhile now you get to be insured.  Post in a year your experience.

[twa]

1)  Really?  We've eliminated the health care expense tax deduction? 

 

I'm amazed that hasn't made the news. 

 

2)  What's the maximum out of pocket if you don't have insurance? 

 

(WD, you can feel free to chime in on this, too.  Since y'all seem to think that listing the maximum amount that people can spend, under various plans, is the fair way to compare.) 

 

Have you seen the requirements to deduct healthcare expenses?(w/o a HSA)......it is not a deduction for most people

 

btw....that maximum is only in network,go out of it and it can get ugly fast

[CrypticVillain]

I try not to get into politics, but now I am being personally effected.

With that being said, can somebody tell me what needs to happen for the government not to get shutdown?

[Bliz]

Even if it was $25 a month with tax credits, that doesn't take into account the max you could pay out of pocket for the year which isn't tax free unless you have an H.S.A plan.  The devil is in the details.

 

Okay, so now we've moved from complaining about high premiums for poor people to complaining about the max out of pocket?  Just want to be sure I know where the goalposts are right now.

 

If you're a person who is probably going to hit your out of pocket max, or your entire deductible, quickly, then it is cost effective for you to go with a plan with higher monthly premiums and lower deductibles/out of pocket max. 

 

 

Scroll down that file and see the deductible. The cheapest one is $5,000 for those "cheap" plans.

 

So you've got a premium of $150/month and another ~$425/month if you want to cover your deductible. This is where people will react.

 

The president clearly wants to focus on cheapest premiums.  That's the # that is most positive for him. He also wants to focus on subsidies. However, your first dollar of coverage doesn't start until you've already spent $6,800 out of pocket.

 

Now...one could argue that this is fine. It's catostrophic coverage, which is really what people need (if not what they want). On the other hand, acting like this is cheap just won't work when the numbers are out.

 

Cheaper plans have higher deductibles.  This isn't anything new.  And this part "However, your first dollar of coverage doesn't start until you've already spent $6,800 out of pocket." is just false.  $6,350 is the max permissible out-of-pocket max for an individual.  But even the cheapest non-catastrophic plan doesn't work that way.  You pay your deductible, then you pay co-insurance until you hit the out-of-pocket max.  Same as it ever was.  And of course you get "dollars of coverage" in other places before you pay your deductible, like co-pays for doctor/er/specialist/etc. and prescription costs.

 

Cheaper premiums are part of the point.  Because for a lot of people (particularly those on individual plans who, say, got cancer, then got dumped by their carrier) being able to afford insurance in the first place is the biggest problem. 

 

An out of pocket max of $6,350 probably doesn't sound so bad to someone who just had a baby born prematurely that had to spend some time in the NICU.  Much better than a $300,000 bill, wouldn't you say?

[AsburySkinsFan]

Well that's some real hardy har talking points.

Those aren't talking points, that's fact. I don't believe the GOP scare machine, and the GOP fought against the Public Option because any gov't involvement in healthcare is apparently socialism. Sorry, but I didn't sleep through those debates nor the ugliness of those town hall meetings.

Meanwhile now you get to be insured.  Post in a year your experience.

Will do, but since I'm under the poverty line, I'm guessing that you're not going to like what you hear from me.

[chipwhich]

Okay, so now we've moved from complaining about high premiums for poor people to complaining about the max out of pocket?  Just want to be sure I know where the goalposts are right now.

 

If you're a person who is probably going to hit your out of pocket max, or your entire deductible, quickly, then it is cost effective for you to go with a plan with higher monthly premiums and lower deductibles/out of pocket max. 

 

I am not complaining about anything, I have health insurance, and a high deductible plan at that.

 

What ya wanted was universal health care, what you got was ability of everyone to purchase health insurance.

 

Now you get to offer people who can't afford what they spend monthly now the ability to spend more monthly, but they have insurance in case of a catastrophy, they just don't have coverage, because that will all be paid out of pocket for the average family with average doctors visits.

Those aren't talking points, that's fact. I don't believe the GOP scare machine, and the GOP fought against the Public Option because any gov't involvement in healthcare is apparently socialism. Sorry, but I didn't sleep through those debates nor the ugliness of those town hall meetings.

Will do, but since I'm under the poverty line, I'm guessing that you're not going to like what you hear from me.

 

I don't watch fox news or any political news stations any more.  So I really don't understand what you are talking about.

[Wrong Direction]

Honestly, pretty much none of this is reality.  There's no arguing.

 

I talk to insurance companies, health insurance companies, every day.  I just got off the phone with one.  I look at their bills, what is paid, and what is negotiated, and what is charged.  I work with Medicare almost every day.  

 

You are not right on the facts of how this works.  

 

So Oncology Analytics doesn't pay more than ASP + 6 for cheaper cancer drugs that are not inferior to or are actually superior to frequently used costly alternatives that the Medicare payment system incents providers to use?

 

Geisinger doesn't put in care management programs for anti-coagulants to improve compliance and thus reduce costly negative adverse events?

 

Kaiser isn't building care models to incent more prevention and adherence to care guidelines (e.g., more physician visits) to prevent hospitalizations?

 

United isn't looking in depth at their data to identify providers who are practicing higher quality care and paying them more and/or getting the lower quality docs out of network?

 

HEDIS alone makes plans put more resources towards better care and incents them to do so through publicly available quality ratings.

 

Maybe you're looking at individual physician bills and not seeing the broader strategies. Or maybe you're not familiar with subcontractors to plans who are implementing care guidelines on things like mental health. I'm not sure, but I also talk with these people a lot and the examples of these types of programs are in every single plan I've spoken to.

[Wrong Direction]

 

Now...one could argue that this is fine. It's catostrophic coverage, which is really what people need (if not what they want). On the other hand, acting like this is cheap just won't work when the numbers are out.

 

 

 

2)  What's the maximum out of pocket if you don't have insurance? 

 

(WD, you can feel free to chime in on this, too.  Since y'all seem to think that listing the maximum amount that people can spend, under various plans, is the fair way to compare.) 

 

I think I answered this before you asked me. See above.

 

This is actually one of the reasons that I'm not terribly against this law. More out of pocket costs means more downward pressure against unnecessary billing or upcoding. Maximum out of pocket limits means catostrophic coverage, which really is what is most important. The ACA sets maximum out of pocket costs ($6,350 individual, $12,500 family). What's amazing is that the plan holder is only getting shared-risk coverage - in Rhode Island at least - for the amount between $5,000 and $6,350, or between $10,000 and 12,500 for a family.

 

I just think people will be against these high deductibles even if they make good economic sense, but we'll see. As an aside, if it were up to me, I wouldn't have a hard cap on out of pocket expenses. I'd prefer a benefit structure with a catostrophic rate, like 5%, that kicks in. A hard cap removes any patient pressure to get better deals or use patient assistance programs for expensive care.

 

There are other positives here as well. I've spoken with one prominent economist who thinks that capitated payments for expensive care will be the most fruitful method for savings. Well, with these plan structures, the plans will be less incented to worry about small dollar items and will instead be focused on squeezing savings out of the truly expensive stuff. Since they now have to focus on pre-existing conditions, they have greater incentives to focus pricing strategies on that care. This is a positive development.

[Elessar78]

I am not complaining about anything, I have health insurance, and a high deductible plan at that.

 

What ya wanted was universal health care, what you got was ability of everyone to purchase health insurance.

 

Now you get to offer people who can't afford what they spend monthly now the ability to spend more monthly, but they have insurance in case of a catastrophy, they just don't have coverage, because that will all be paid out of pocket for the average family with average doctors visits.

 

I don't watch fox news or any political news stations any more.  So I really don't understand what you are talking about.

That's not exactly true. As you write it only the poor will be signing up for this, but the poor already have insurance through Medicaid. It's more like middle class families whose primary breadwinners are either self-employed (contractors, real estate agents, etc etc) or work for companies that don't offer health insurance.

 

Now these self-employed people can get insurance for themselves or their family much more affordably and the small companies are forced to offer healthcare but now what once was unaffordable to a company their size can get rates that were previously only available to big companies. Small companies can now pool together to get the rates.

 

When I started out in my career, my industry (advertising and design) was filled by many small firms. I always wondered why "we" never pooled together since we have an overarching member organization to get better insurance rates. Now this does exactly that. 

 

Additionally, I live in Western, PA where we have two predominant providers for decades who have a virtual monopoly. Now this can introduce much needed competition to the area. 

[twa]

Can anyone tell me if a 3500 ded HSA plan is going to be  fined?

[Wrong Direction]

Okay, so now we've moved from complaining about high premiums for poor people to complaining about the max out of pocket?  Just want to be sure I know where the goalposts are right now.

 

If you're a person who is probably going to hit your out of pocket max, or your entire deductible, quickly, then it is cost effective for you to go with a plan with higher monthly premiums and lower deductibles/out of pocket max. 

 

 

 

Cheaper plans have higher deductibles.  This isn't anything new.  And this part "However, your first dollar of coverage doesn't start until you've already spent $6,800 out of pocket." is just false.  $6,350 is the max permissible out-of-pocket max for an individual.  But even the cheapest non-catastrophic plan doesn't work that way.  You pay your deductible, then you pay co-insurance until you hit the out-of-pocket max.  Same as it ever was.  And of course you get "dollars of coverage" in other places before you pay your deductible, like co-pays for doctor/er/specialist/etc. and prescription costs.

 

Cheaper premiums are part of the point.  Because for a lot of people (particularly those on individual plans who, say, got cancer, then got dumped by their carrier) being able to afford insurance in the first place is the biggest problem. 

 

An out of pocket max of $6,350 probably doesn't sound so bad to someone who just had a baby born prematurely that had to spend some time in the NICU.  Much better than a $300,000 bill, wouldn't you say?

 

A few points to respond here:

 

1. If you are very expensive, yes, it certainly makes sense to enroll. But what if you're not very expensive? Do you want to enroll in a plan that will cost you $1,800/year in premiums with $5,000 in out of pocket costs before coverage beyond basic prevention kicks in?

 

2. If realitively healthy people don't like the value proposition in #1 (and that's a personal decision), then plans will be stuck insuring only the costliest people. This will make it really hard to keep premiums low over time...which will create more of a disincentive for healthy people to enroll. It's a bad spiral if it unfolds that way.

 

3. Your out of pocket amount is just wrong. Premium costs don't apply to the $6,350 limit. So in the case of the Rhode Island plans, you're looking at $1,800 in premium committments plus the deductible before you get coverage.

 

4. If you look back over the last few pages, I'm clearly not hyper-partisan about this bill. I've noted what I like and what I'd do differently.

I try not to get into politics, but now I am being personally effected.

With that being said, can somebody tell me what needs to happen for the government not to get shutdown?

 

The house and senate need to pass a bill that 1) agrees on non-ObamaCare spending, 2) agrees on ObamaCare spending and 3) agrees on the personal mandate in ObamaCare. And then the president has to sign it.

 

Much easier said than done. I have no idea what the probabilities of this happening are, but those are the 3 high-level points of contention right now.

[chipwhich]

 

 

4. If you look back over the last few pages, I'm clearly not hyper-partisan about this bill. I've noted what I like and what I'd do differently.

 

It's refreshing, and rare in the tailgate lately.  Actually discuss the facts without political barking.

What I am curious about is...

1)  Other than the premium is anything tax deductible?

2)  How/when are these premiums tax benefits occur?  (i.e my employees premium comes out of their paycheck tax free)  Curious if the tax benefit is part of your end of year tax filing or when the premium payments occur.

3)  Are the out of pocket expenses tax deductible.  On my employees current plan, they are not.  Not sure under ACA.  If so how do you show that on your taxes.

[Wrong Direction]

It's refreshing, and rare in the tailgate lately. Actually discuss the facts without political barking.

What I am curious about is...

1) Other than the premium is anything tax deductible?

2) How/when are these premiums tax benefits occur? (i.e my employees premium comes out of their paycheck tax free) Curious if the tax benefit is part of your end of year tax filing or when the premium payments occur.

3) Are the out of pocket expenses tax deductible. On my employees current plan, they are not. Not sure under ACA. If so how do you show that on your taxes.

 

#1. No, except for my answer to #3. I'm only about 80% sure I'm right though.

 

#2. My impression is the tax benefits will have to occur in your end of year filing. This may change in the future if the IRS and health plans can get systems that talk well with each other.

 

#3. I'm pretty sure that out of pocket expenses are only tax deductible above some catostrophic threshold. However, my understanding of that is based on previous tax returns more than knowledge of this law. In previous returns, your out of pocket expenses had to be like $12,500 before you could start claiming a deduction. I really have no idea what the ACA did to that. It's worth noting that the out of pocket threshold is only applied to the exchanges. People in employer plans, for example, could still hit that previous threshold to qualify for a write-off. If this assumption is true, people in the exchanges would never qualify for an out of pocket write-off beyond the low-income subsidies they'll separately qualify for. If all of those assumptions are true, this would be another example of an incentive for people to go into the government system, which will raise costs and premiums.

[chipwhich]

Thanks Wrong Direction.  I do know if you go with the better plans which include a Health Savings Account (H.S.A) you can pay for your deductible using pre-taxed H.S.A dollars.  I just don't know how under the ACA you would get the dollars pretaxed into you HSA account.  My employees get it through payroll.

So everything premiums, and deductible is paid on pretax $$$$.

[Bliz]

fyi chip, there is also going to be some tax credits available against the portions of the premiums paid by your company, if you have no more than 25 full time equivalent employees, and their average annual wages are under $50k.  But you only get it for 2 consecutive years, and with the delay of the employer mandate, I'm assuming 2015 would be the first year you can take it.