Earn too much to qualify for Premium Subsidy-now what?

Ok, many individuals and families earn to much to qualify for premium assistance but due to monthly obligations they have no monthly disposable income to pay the premiums they are quoted. Whether you qualify for premium subsidy is based on the arbitrary formula mandated by HHS/IRS, a modified adjusted gross income that doesn't take into account any non-tax deductible monthly loan payments or expenses. Such as credit card monthly payments, food, gas, electric, clothing, and so on. HHS formula may indicate you have the monthly income to afford insurance premiums but it only includes monthly expenses that are tax deductible and fails to include non tax deductble monthly living expenses.
Therefore, On paper one may look as to be able to afford health insurance premiums but in reality can not.

If you are self employed and on the cusp of income that qualifies you for a subsidy or not you are better off shifting some of your income to the fiscal year, taking the subsidy you qualify for, going without insurance if you earn too little or applying for Medicaid if you qualify.

 

Hu

So what is your point? Do you want to expand the subsidies? Go to a single payer system? Or go back to the past prior to the ACA.

Everyone pretty much recognizes the old system was broken , and that the ACA is not perfect. The problem now is that the Republicans see dedicated to gutting the ACA without having any plan to replace it that will deal with the Hugh number of uninsured and the costs involved. It is easy to criticize but much harder to come up with fixes. And probably less politically rewarding if your only real objective as a party is to win the next presidential election at any cost.

 

Due to a "life change" I am going off my previous insurance and having to go on my own policy.
Previous cost us $177 month (my company reimbursed the $128 spousal coverage) to us so a net $49 a month or $588 a year
$500 individual deductible $1800 max out of pocket
$1250 family deductible $4500 max out of pocket

I am out of state from the company I work for and for insurance they will give me an allowance equal to the monthly cost of the in state employees which currently is $444 a month to purchase my own plan but we just found out that under Obamacare that is taxable so I will net approx. $333

One Obamacare plan BCBS

$728 a month so less the $444 less taxes or $395 a month or $4740 per year and increase of $4152 per year
$500 deductible, no increase, $5000 max out of pocket or $3200 increase

Lower plan
$559 a month so less the $444 less taxes, $226 a month or $2712 per year and increase of $2124 per year
$2400 deductible, increase of $1900, $6300 max out of pocket or $4500 increase

Thanks Obama, my cost are going way up

 

Go back to what we had, fix the little things and make the market more competitive and more flexible for the rest of us.

 

What was wrong with the old system wasn't going to be fixed with little tweaks. Higher percent of GDP spent on healh care than almost all other developed countries and yet poorer results. 40 plus million uninsured, and no insurance for pre existing conditions.

Also companies were reducing employee coverage and increasing copays. Even the Republicans thought the old system was broken and would eventually bankrupt the country.

 

The system is still the same.......

costs are not down.......

only thing is shifting who pays......

Insurance is risk management............the ACA took that away and just made them a payment system

 

The ACA is the start not the end.

 

They don't have to be necessarily little but we see the mess "comprehensive" health care reform has caused.

Yes we are able to and do do a lot of health care in this country but then trying to equalize and compare to every other country in the world when health care is provided through immensely different means and paid for by vast differences is an exercise in folly.

First, no health insurance does not equate to no health care and both could have been better handled as separate issues rather than a boondoggle comprehensive take over by the government. How many with effectively without insurance now because they have to pay $6,000-$10,000 deductibles?

Health care cost had been falling for decades and had practically bottomed out even before Obamacare.

Even Republicans though changes needed to be made, market based changes and that those changes should have been bipartisan and fully vetted in Congressional hearings with accurate numbers and predictions of the effects of each proposal. THAT did not happen and look at the mess we are going to be in. My cost are going to SKYROCKET and with less care.

- - - Updated - - -

Really? Tell me what needs to be fixed and what has the Obama administration offered to fix it?

 

"Market-based changes" used to be shorthand for higher deductibles. More consumer skin in the game, greater responsibility on the individual (not third party payers) at the point of care, breeding both individual consumer responsibility and greater provider competition for the business of increasingly price conscious consumers. This is being achieved, so naturally now we're on to something else.

What does it mean now?

The "practically" qualifier is presumably an acknowledgement that it got even lower under Obamacare (to an unprecedented degree)?

Health care spending [in 2013] grows at lowest-ever rate
Per Capita Medicare Spending is Actually Falling
Employee Health Insurance Costs Barely Increased This Year

 

No it was and still is shorthand for more compeition, Obamacare was and still is shorthand for higher deductibles.

No it's not in fact the two insurance brokers I have talked to have been clear about there is little if any competition left.

Actually it have pretty much plateaued under Obamacare.

Yes that rate has been falling for decades did the article say that we had the greatest fall in that rate under Obamacare? In was already low before Obamacare.

And BTW Obamacare did not come into effect until 2014 so why are you touting the fall in 2013?

 

Since that is not what I said but what we should learn from those other systems is how they are going broke and can no longer provide free health care nor the services they once promised.

So Why would you think that learning from other tested systems that deliver much better results at considerably lower cost is an exercise in folly.

"Health Reform: The latest government report on national health spending provides more evidence that ObamaCare will act as poison to a health care system that was already on the mend.
In 2011, the last year for which data are available, spending on health care climbed just 3.9% for the third year in a row.
The press is dismissing it as the result of the recession, while the Obama administration claims ObamaCare deserves credit. Neither is true.
Health spending skyrocketed during previous economic slumps — it saw double digit increases during the deep, prolonged 1981-82 downturn, for example.
Plus, the spending trend had been falling for years before the last recession, dropping from 7% in 2004 to 4.7% in 2008. In any case, even after the recession ended in mid-2009, spending growth still slowed.
Insurance premiums showed the same trend. According to the Kaiser Family Foundation, annual family premium increases fell from 9% in 2005 to 5.4% in 2007, and to 3% in 2010.
The health care market, it turns out, was already figuring out how to control costs long before ObamaCare. Witness the explosive growth in Health Savings Accounts.


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Higher deductibles = greater consumer price sensitivity (for health services priced under the deductible) = greater price competition among health care providers

For ages that's been one of the primary goals of anyone talking about "market-oriented" reform. For instance, it's the rationale behind the creation of health savings accounts--consumers, instead of third party payers, ought to be paying for more of the cost of their services and in exchange we can let them use tax privileged dollars saved for just that purpose to cover their cost-sharing obligations. Handing control, and thus responsibility, back to the consumer is the heart of "market-based" reform. How is this even something that needs to be pointed out?

Greater insurance market competition is only part of the battle, the shift toward greater consumer cost-sharing gets at the other half (health care provider competition). Anyway, on the insurer side of the equation, it's clear what's happening:

More Competition Helps Restrain Premiums In Federal Health Marketplace

The coverage expansions took effect in 2014, but it isn't the expansion of coverage that's going to control costs in the long run. It's the changes in the way health care is paid for and delivered, which started almost as soon as the law passed back in 2010. It's been driving changes in care delivery--improving quality and encouraging cost efficiencies--for a few years now.

 

So was the "War on Poverty": A start that today cost States and Federal resources, over a Trillion Dollars per year. Supposedly it was to become cost efficient (balance out to -0-/yr in the 1980's). As a Nation last year, we spent in total 3T$ on HC alone. Please think...that's 4T$ out of a 16T$ GDP, logically creating a T$ deficit on an increase and we have no way of making this up, other than making the $ less valuable (inflation) or restricting service or quality.

The 2 Clinic's where I live have a combined total of 4 Doctors (6 yr ago 14 Doctors), 10 practitioners, trying to increase the practitioners, as Doctor's move on. Around this town of 34T, we have few full time physicians, as most are floating from town to town in the area...If you have a Heart Attack, it better happen on Tuesday between 10-12AM or you will be flown 90 miles, subject to a 20K$ COST, if available.

To be fare, we have 2 rather large Hospitals in the area, I know little about. I do know many of the Specialist Doctors come from elsewhere and assume each has some permanent Doc's to diagnose, where to send them. None of this could have been said 12 years ago, when I decided to move here....

 

Higher deductibles, lower deductibles, variable out of pocket along with variable coverages REAL MSA accounts, a lot more than just "higher deductibles".

And we have moved from that with only ONE coverage plan.

The signups began in 2014 the low increase rates predate that by years and you stat was from 2014 BEFORE Obamacare, thanks for proving my point.

And no comment on the actual facts about the cost slowing down DRAMATICALLY long before we even knew who Obama was and that rate has only decreased slight if not gone up some under Obamacare. A good chunk of the bragged about GDP number last quarter was because we are spending MORE On health care now that Obamacare is in place. My cost are about to skyrocket.

 

Lower deductibles are the antithesis of consumer-oriented, market-based reforms. They shield consumers from the cost of the services they're consuming. Are you sure you're thinking this through?

And the ACA's delivery system reforms have been ongoing since 2010. There are now hundreds of functional accountable care organizations coordinating care, thousands of hospitals have been working with Hospital Engagement Networks to improve patient safety, payments to providers and to Medicare Advantage plans are now linked to quality performance and efficiency, millions of dollars have been awarded to states and their private sector partners to reform their health care delivery systems, and so on. This has been going on a lot longer than a year.

Bottom line: it has been (and continues to) changing the way health care is delivered, emphasizing better quality and slower cost growth. And the heads of delivery systems around the country have pointed out that incentives the law has been rolling out not for almost half a decade have been pushing them to change the way they do business.

Delivery systems like Partners in Boston:

Or the Cleveland Clinic

The ACA has been the kick in the pants the industry desperately needed to start getting its house in order. And we're seeing some fundamental shifts in the health system--a path to actual sustainability--as a result.

 

Exactly, the problem with US healthcare existed prior to the ACA. That is why the ACA has to be maintained and strengthened. Because healthcare costs in the United States are out of control. The only thing you are missing is that they were just as bad or worse prior to the ACA.

The real solution would be a single payer system which seems to work very well in most developed countries.

 

If you actually bother to read the article it says healthcare premiums spiked 9% in 2011 and increased only 4.5% last year which indicates that the ACA is working.

ALso note that the chart in the article is talking about Medicare and Medicaid costs not total healthcare spending. This is a typical IBD article with a strongly political slant that uses misdirection and confused data to make its point.

 

Obviously more than you. Flexible plans and coverages with a multitude of providers is the key to consumer based market oriented systems.

It was implemented in 2014.

And so what? It wasn't implimented until 2014. Did people PLAN for it, of course.

And no evidence any has come to fruition and as already shown cost had been decreasing for years and that decrease has plateaued and we now see horror stories as my own as cost to the consumer are skyrocketing.

I have no idea what you are trying to claim here, can you try again.

It was sustainable before as cost had been drastically lowering BEFORE Obama even went to Washington, but if Obamacare continues as it is going IT will unsustainable and millions who once had insurance and received regular health care and were able to afford their health care no longer will.

OH and add another $41 a month as I will now have to buy a separate Dental plan.

So bottom line admit cost were being cut drastically BEFORE Obamacare and the claims it is Obamacare have brought cost increase to these levels is entirely bogus.

 

If you read the article

Plus, the spending trend had been falling for years before the last recession, dropping from 7% in 2004 to 4.7% in 2008.

And it is total national healthcare spending not just Medicare and Medicaid which those cost were supposed to come down too.

And also

Insurance premiums showed the same trend. According to the Kaiser Family Foundation, annual family premium increases fell from 9% in 2005 to 5.4% in 2007, and to 3% in 2010.

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The only way, a centralized HC system for 330 Million people could work, unfortunately would be "Single Payer", paid for as in most Countries that have tried this system, with AVT (added value tax) which cost ALL consumers up to 20% for products or sometimes services. It's possible States could set up there own systems more efficiently, since there going to in the end be paying much of the cost anyway, but politics, would still be involved,

In my mind ACA, was or is an extension of Medicare/Medicaid, which in short CAUSED the rise in HC cost for everyone, In order to cover free or mandated prices, those not on those systems, were forced to make up the differences, with a steady increase in those receiving free or mandated price controlled HC.

For an example, Cuba has near total free HC for all 20 million people. Rather than taxing, they simply pay all wages in Cuba, today about $30.00 per month and have total control over what's required to be in the medical field. Certified Doctor's or Nurses, would not qualify in the US, but it's all the people have and they can't afford to get to Europe, where their leaders go for HC. Cuba has also received help to pay their cheap labor, first from Russia, then the UN and other sources, which the US could never receive.

 

No, really. These things have been going on for years. You're correct at least that provider behavior began changing in anticipation of the coming changes as early as 2008/2009.

The ACA has been actively re-shaping payment and influencing shifts in health care delivery (as well as providing technical assistance to speed change) for years now. For instance:

Hospital Value-Based Purchasing

Guess what? Hospitals have been improving their quality performance under this program, consistent with findings from the organization that accredits hospitals: Hospital quality increases, accrediting group says.

Readmissions Reduction

Early results are in: formerly stubbornly persistent readmissions rates have been dropping since 2012 and the savings are mounting.

Community-based Care Transitions (and dozens more like it) have been helping to push providers along.

The public-private Partnership for Patients (along with its Hospital Engagement Networks) to improve hospital quality launched in 2011.

The results so far? Since 2010, billions of dollars saved, and over a million patient harms averted.

For a look at what the HENs have been up to: Hospital Engagement Networks participants make big strides in reducing patient harm and readmissions.

The first accountable care organizations launched in 2012. There are over 400 of them serving millions of patients, with spillover effects benefiting who knows how many millions more.

This is enrollment in ACOs by hospital referral region, as of last fall:

Percentage of lives covered by Accountable Care Organizations, by hospital referral region


Evaluation results from the first year of the MSSP ACOs and through the second year of the Pioneer ACOs are also available. Topline: they're saving money and improving care quality.

Payments to Medicare Advantage plans have been linked to quality since 2012 thanks to the ACA.

Medicare Advantage Star Ratings and Bonus Payments

The results were immediate, showing up in the National Committee for Quality Assurance's quality analyses by 2013 ("This year [2012] we saw significant improvement in measures included in the Medicare Star rating pay-for-performance program for health plans that participate in Medicare Advantage. [...] the Affordable Care Act required the Medicare program to make higher payments to health plans with better quality performance, starting in 2012. In addition to this new program, the Department of Health and Human Services established a demonstration program to complement it, making even higher payments to plans with better performance.")

As I already said, the parts of the ACA that are reforming health care, re-shaping the way health services are paid for and delivered, have been ongoing for years. 2014 was the magic year for expanding coverage, not re-shaping the health system. The latter began a while back. And yes, we're already seeing the benefits.

If you walk into a hospital or provider organization today, you're going to get better, safer care than you would have pre-ACA. And that saves everyone money.

 

Obama was right, we needed a public option....

these same people you speak of could not afford coverage or to get sick in the old system... and they still could not afford coverage

they are living higher then their means by gambling on not getting sick

which is why I think the public option Obama wanted is a better option imo

if republicans were to write a new health care bill with a public option, they could steal the thunder from democrats, would that not be a twist we did not see coming....

republicans control Congress for the next two years, lets see if they offer a better health care package that addresses the issue you mention....

.

 

Many of these people had coverage with benefits they needed and due to arbitrary "minimal essential coverage" mandated after the act passed and without congressional approval they lost that coverage along with their Doctors and Hospitals.
Whether these people were living above their means is unknown. But one thing we do know is that Obama and the Dems promised(prior to passage of the Act) that where an individual or family did not earn enough to pay premiums quoted on the "exchanges", they would be eligible for premium assistance.

IMO the Federal government should have expanded Medicare to include a program that would cover those unable to purchase insurance due to pre-existing conditions. By pooling these individuals it would lower the overall premium and cost of insurance. Instead, they stuck it to the rest of us to pay more.