Can anyone explain how Obamacare will change things for our family (self-employed, OOP payments)

[Murphy101]

What you quoted is the data is spits out for a family that size with an income of $165k. That extra $100k makes a bit of a difference.

 

NO. It is NOT. I even went and redid the calculator just in case I made an error and got the same result. I never said 165k and I have never in my life made even half of that, so I have no idea why you would use that number.

[Laurel]

NO. It is NOT. I even went and redid the calculator just in case I made an error and got the same result. I never said 165k and I have never in my life made even half of that, so I have no idea why you would use that number.

 

Read my previous posts. The fault is in the calculator page.

[SJ.]

I meant typical at his company, not typical for everyone.

 

Thanks for the clarification. :001_smile:

[Murphy101]

I'm using the exact same calculator. I just think it doesn't recognize the decimal point and so it read what you inputted as 6500000.

 

Ahhhh. Now that is a programming error. Wth would it ask about money and not recognize a decimal point?!

Anyways. Apologies.

Removing the decimal does indeed give the data you quote.

:)

 

Given that data...

 

We would be better off without the coverage and just paying the penalty, tho I bet we will qualify for the exemption

 

 

[Slartibartfast]

You do have awesome insurance. This sort of coverage is not happening for any professionals we know here. Employers are offloading more and more of the costs onto the employees. So income is dropping.

 

The 100% is based on my husband's years with his company. They have a sliding scale depending on how long someone has worked there and at ten years it is 100%.

 

He works for a gasoline retailer. I think if a gas station company can offer insurance and even 100% off insurance (in many instances) to it's employees then many of these other companies can as well.

 

Income has been dropping, that is not new and it is not due to insurance.

[Halcyon]

THe problem for us is that our income varies wildly every year. I am talking 40,000 wild. So how would we go about determining what we should pay? Is it based on prior years, and then they either make you pay money back (if you make more) or give yoou a credit (if you make less)

[butterflymommy]

We would be better off without the coverage and just paying the penalty, tho I bet we will qualify for the exemption

 

I wonder if it would be cheaper to pay the penalty, then purchase insurance if it became required, since people will not be turned down for pre existing conditions starting 2014. Personally we have too many health issues in our family to go without but in theory the penalty might be cheaper for a family that doesn't really use their coverage.

 

But as another poster mentioned, none of this is a free ride. I don't think anyone knows what it will end up costing long term, both at the federal and individual level, and what the effect will be on the health care system. If dr compensation goes down I think we'll eventually end up with a markedly two tier system with certain drs refusing to participate in any insurance and the lower tier drs who will accept insurance payments. You will also possibly see a depressive effect on research, innovation, and quality of care since the higher compensations won't be there as a carrot.

 

The working poor/ lower middle class will benefit but middle & upper middle class families will be hit very hard-- unless the exchanges really do bring down costs for strong (i.e. truly comprehensive coverage) plans.

[Pawz4me]

You do have awesome insurance. This sort of coverage is not happening for any professionals we know here. Employers are offloading more and more of the costs onto the employees. So income is dropping.

 

My DH's employer covers all of his insurance and 70% of our family coverage (the part that covers me and the boys). Our part of it went up just a few dollars per pay period for next year -- the smallest increase we've had in about a decade. And no change in deductibles or co-pays.

[misty.warden]

I'm in the same boat as TranquilMind, a lot of what people say is awesome about the Affordable Health Care Act does not and probably never will apply to me. Getting a penalty for not paying for an insurance policy you can't afford because someone who doesn't know your situation decided up to 8% of your yearly income is the perfect amount to pay for insurance while, in the meantime, my taxes increase to keep paying for other people's insurance subsidy AND my tax refund goes to paying off the penalty? Sounds like a recipe for disaster for me personally.

[SJ.]

I'm in the same boat as TranquilMind, a lot of what people say is awesome about the Affordable Health Care Act does not and probably never will apply to me. Getting a penalty for not paying for an insurance policy you can't afford because someone who doesn't know your situation decided up to 8% of your yearly income is the perfect amount to pay for insurance while, in the meantime, my taxes increase to keep paying for other people's insurance subsidy AND my tax refund goes to paying off the penalty? Sounds like a recipe for disaster for me personally.

 

8%? That is a lot! If we had to pay that we would be able to pay for absolutely nothing outside of basic living needs.

[Halcyon]

8%? That is a lot! If we had to pay that we would be able to pay for absolutely nothing outside of basic living needs.

 

that's about what we pay. actually, wait. we're more like 10% now.

[SJ.]

that's about what we pay. actually, wait. we're more like 10% now.

 

:eek: :thumbdown:

[Murphy101]

I wonder if it would be cheaper to pay the penalty, then purchase insurance if it became required, since people will not be turned down for pre existing conditions starting 2014. Personally we have too many health issues in our family to go without but in theory the penalty might be cheaper for a family that doesn't really use their coverage.

 

The only time we have used our insurance in the past four years has been for dh's toe 1 diabetes medications and an emergency cesarean. And the medications are still very expensive for our portion and the cesarean still has not been paid out on baby who is now 1.5 years old.

 

If dr compensation goes down I think we'll eventually end up with a markedly two tier system with certain drs refusing to participate in any insurance and the lower tier drs who will accept insurance payments.

 

This is what we have started doing. The care has been far better and the cost has been cheaper than deductible/copay so we just don't even bother using the insurance we are paying a bloody fortune for.

 

The working poor/ lower middle class will benefit but middle & upper middle class families will be hit very hard-- unless the exchanges really do bring down costs for strong (i.e. truly comprehensive coverage) plans.

 

I would put us in the lower middle class ballpark and so far we just keep getting hit by one financial blow after another.

[mamajag]

Sorry for the sidetracking but I take exception that $3 per pay period is the typical amount out of pocket in increases people will see due to the AHCA.

 

 

My DH's company raised rates by $5 per pay period, which is the smallest increase we've ever had. The Affordable Care Act savings were pointed out as the reason our rates didn't go up by the usual $20 to $30 a pay period. We pay $178 a pay period for very good insurance for the whole family.

[QueenCat]

Kids being on the insurance until 26 is not "free" either. One site said that this adds an extra $3400 a year to the policy, and someone is paying this. All of us are paying this. And they will have the same crap coverage too, if something actually happens. Some will argue that it is better than nothing, and maybe that's true. But if you have "access" to a policy you still can't afford, then government subsidies (meaning everyone else pays) kick in so you can purchase your mandated policy. It may or may not be good insurance, and we are all covering the costs that only those to whom they applied used to have to cover.

 

 

Really depends on your company's plan. DH's employer does not charge extra for the young adults for keeping ds on our plan. They've said the premium is the same from BCBS regardless of age of the dependents. Our coverage is excellent, not crap. That's also dependent on the plan you or your employer chooses. Some of that has been the same for years upon years.

[jallison25]

ok, when i went to the link to figure out how much it would cost us, it said our federal premium subsidy would be $201, meaning we will pay 500 a month!!!! that is about 440 more a month than we are paying now!!!!!!!. Then it said our limit of deductibles and all that is 8k!!!!! WHAT???? Our limit right now is 6k and we are paying less per month...that seems...sucky or something

[Amy in NH]

Things are so nuts that I read in the paper today that some guy is getting his weekly Testosterone shot covered by his insurance plan, whereas MY crap insurance plan (and spouse is an attorney here - it is hitting all levels of professions/trades) didn't cover a dime on my kid's antibiotic - the one time in five freaking years I needed one for him - so I paid forty dollars cash (and 45 for the appointment at a clinic) after they checked. Nice priorities there. But I don't mind paying for my rare visit and antibiotic, if everyone else would just pay for their own stuff too, so insurance rates would stay reasonable and cover all important stuff, as they always did.

 

[snip]

 

Do you think any of us will have this? I don't. By sharp contrast, two days after arriving home, I got an immediate $6,000 bill out of pocket for uncovered costs last year when I was in the hospital for the first time since childhood. Many other bills followed, all under the "good" previous insurance we had. Now the company has moved to the cheaper insurance because of this ruling. The same bill today under new coverage would be in excess of $10,000 immediately upon exiting hospital.

 

So...all those people that are thrilled that the yearly well appointment will be covered by increasing the premiums for everyone (because nothing is free) and are happy about their "free" birth control and OB visits will not be so thrilled when they need coverage for something other than the stuff that used to be cheap, like well visits and common drugs.

 

I'd much rather pay for my OWN well appointments, drugs, births, ob-gyn stuff - as I always have - and let the insurance really cover the bigger, more important things that we used to be able to turn in. Now we have to carry some stupid credit card around and if you forget, too bad for you. All out of your own pocket. I can't believe people think that being given the relatively inexpensive well care appointments and birth control in exchange for good coverage of the disastrously expensive specialty care is a worthy exchange.

 

[snip]

 

 

So nice that you can afford to pay. The reality is that many working people cannot (including us, even with our crappy insurance).

[Mommyof4ks]

ok, when i went to the link to figure out how much it would cost us, it said our federal premium subsidy would be $201, is that our monthly amount we would pay? that is about 140 more a month than we are paying now but we have paid that before, so no problem there. Then it said our limit of deductibles and all that is 8k!!!!! WHAT???? Our limit right now is 6k and we are paying less per month...that seems...sucky or something

 

 

Yep, we lose too. We pay very little, like laughably little in premiums with a max out of pocket of $5000, but the calculator says we would pay over $700 a month for premiums and over $8000 max. We cannot afford that. :(

 

OP, keep your insurance, and in your situation you will just have more choices, but the cost might be the same, higher, or you might luck out and get a cheaper premium. The healthcare plan is not insurance, just regulations.

 

Does anyone know yet if we can appeal when insurance does not want to pay? There was a lot of chatter about that last year, but no one knew for sure. We had to appeal a few very big bills, and we won every time, so I need that option.

[astrid]

My state has repeatedly passed measures to guard against ObamaCare. Will that protect us from having to comply with it?

 

 

Again, it's not "Obamacare." It's the Affordable Health Care Act.

 

astrid

[CAMom]

Again, it's not "Obamacare." It's the Affordable Health Care Act.

 

astrid

 

 

Just reading through since this will likely affect us in some way. We own our company and provide insurance for 5 families (including our own) and it costs $6000 per month.

 

But...even the President said he's fond of the term "Obamacare." :)

[nmoira]

ok, when i went to the link to figure out how much it would cost us, it said our federal premium subsidy would be $201, meaning we will pay 500 a month!!!! that is about 440 more a month than we are paying now!!!!!!!. Then it said our limit of deductibles and all that is 8k!!!!! WHAT???? Our limit right now is 6k and we are paying less per month...that seems...sucky or something

 

 

The total cost of your current premium is $60 per month?

[redheadmom]

I am still not sure how I feel about this program yet. Due to the great thread on here about why people love universal healthcare, I have changed some of my opinions. Obviously this is not anywhere near that yet. Right now we get insurance through DH work. I put our info in that calculator and if we had to choose that option it would be $355 more a month than we are paying now. I don't see how that helps us at all. It would make things very tight. However, I know a couple without insurance and it would benefit them. So confusing.

[TranquilMind]

My DH's company raised rates by $5 per pay period, which is the smallest increase we've ever had. The Affordable Care Act savings were pointed out as the reason our rates didn't go up by the usual $20 to $30 a pay period. We pay $178 a pay period for very good insurance for the whole family.

 

 

Aren't you military?

[TranquilMind]

Again, it's not "Obamacare." It's the Affordable Health Care Act.

 

astrid

 

 

Well, two responses to this:

 

Obama himself said he had grown fond of the term.

 

I cannot call it the "Affordable" Health Care Act. It makes NOTHING affordable; it doesn't begin to even approach the problem of exponentially rising costs. EVERYTHING will be more expensive to support the bloated infrastructure and the hundreds of IRS Agents to hunt you down if you don't pay.

I just can't do that with a straight face.

[TranquilMind]

So nice that you can afford to pay. The reality is that many working people cannot (including us, even with our crappy insurance).

 

 

I know! I could afford that $85 out of pocket yesterday for the child's antibiotic (while other less important things are covered). Not everyone can. This is the travesty that will create exactly the scenario that the dreamers think will change: tiered care.

[justasque]

We would be better off without the coverage and just paying the penalty, tho I bet we will qualify for the exemption

 

 

But if you pay the penalty, you get no insurance. Whereas if you pay for the coverage, about $2k more a year (or $166 a month), you get insurance for 8 people. Which is $20 a month per person. Which is a pretty darn good rate.

(Ok, it's more like $40 if you add in the penalty, which you'd have to pay whether you got the insurance or not.)

You could easily eat up three to four months worth of premium in one office visit plus a prescription. And if anything serious happens, or even just semi-serious, you're covered. One fairly minor visit to the ER could cost half your yearly premium. And with 6 kids, it's not an unlikely scenario. And better yet, you (not you personally - just an example) wouldn't have to be on the boards saying "should I take this kid in?", you could just go. And a catastrophic event or illness wouldn't bankrupt you. I mean, $4K a YEAR for insurance for EIGHT people? That's a really good price.

[misty.warden]

Eliana, if discussing whether or not this can turn into tiered care hypothetically is making this thread political instead of talking about it as a healthcare system and how it may apply to any situation, then this whole thread should be banned, along with any posts talking about the legality of homeschooling or any other issue and government rules regarding said issue. As far as I can tell, no one has started ranting about "liberal evil this" or "republican fascism that" or organizing a campaign to repeal, which is how *I* understand the ban (please mods, correct me if I'm wrong). If we're not allowed to talk about anything having to do with government and current events outside small pigeon-holes of "respond only to the OP and fortheloveofGod don't go down any related rabbitholes" then I'd like to see where that was stated.

[Slartibartfast]

Yep, we lose too. We pay very little, like laughably little in premiums with a max out of pocket of $5000, but the calculator says we would pay over $700 a month for premiums and over $8000 max. We cannot afford that. :(

 

OP, keep your insurance, and in your situation you will just have more choices, but the cost might be the same, higher, or you might luck out and get a cheaper premium. The healthcare plan is not insurance, just regulations.

 

Does anyone know yet if we can appeal when insurance does not want to pay? There was a lot of chatter about that last year, but no one knew for sure. We had to appeal a few very big bills, and we won every time, so I need that option.

 

 

It doesn't require existing plans to change. Why would you lose your insurance?

 

If you look at the calculator that is not a price that you will be expected to pay. The premium amount is what your limit will be. If your insurance is cheaper than that you are not going to be expected to pay more. I don't know how much my dh's company pays for our insurance, but it is likely more than what that calculator estimated.

 

The premium amount is an estimate. The max out of pocket is how much it will need to be before your government subsidies will kick in. We have not seen anything to indicate the actual prices. The exchanges are not yet here.

 

http://www.healthcar...nges/index.html

 

There is a note on the calculator

 

Notes: This calculator shows expected spending for families and individuals eligible to purchase coverage in the Exchange under the Affordable Care Act. Under the law, maximum contributions to premiums will be based on modified adjusted gross income, while estimates in this calculator are based on the annual income entered by the user. Actual premiums in the Exchange are not yet known. The premiums in this calculator reflect national estimates from the Congressional Budget Office for 70% actuarial value plans, adjusted for premium inflation and age rating. Premiums are shown in two tiers: individual and family (two or more family members), though premiums in the Exchange will vary based on additional family tiers which are yet to be determined. Coverage in the Exchange will begin in 2014, but the spending amounts are estimated in 2012 dollars.

 

The Affordable Health Care act requires an appeals process for all insurance companies to dispute denial of claims. That is in the bill.

 

http://www.healthcar...gram/index.html

[Slartibartfast]

Just reading through since this will likely affect us in some way. We own our company and provide insurance for 5 families (including our own) and it costs $6000 per month.

 

But...even the President said he's fond of the term "Obamacare." :)

 

 

Very small companies who pay for employee healthcare can receive subsidies once the exchanges kick in. That is in the bill.

 

 

If you have up to 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This will bring down the cost of providing insurance.

Starting in 2014, the small business tax credit goes up to 50% (up to 35% for non-profits) for qualifying businesses. This makes the cost of providing insurance even lower.

http://www.healthcare.gov/using-insurance/employers/small-business/index.html#taxcredit

[Slartibartfast]

I know! I could afford that $85 out of pocket yesterday for the child's antibiotic (while other less important things are covered). Not everyone can. This is the travesty that will create exactly the scenario that the dreamers think will change: tiered care.

 

 

We already have tiered care. Thousands die every year because they cannot afford it.

[GWOB]

I cannot believe I am wading into this discussion, but it is late, my husband is not home, and I have insomnia.

 

My crazy mother, bless her psychotic heart, almost died on the floor of a charity hospital (which is now being de-funded thanks to a certain political party's governor) because she had no healthcare. Both parents worked full-time, yet they were not provided with healthcare. Even though both worked full time, they never made over $40,000/year. We had a family of 5. I suffered so much because of the lack of healthcare. I often missed weeks of school because we could not afford a doctor visit.

 

Right now we would not qualify for government assistance in purchasing healthcare. Dh works for a public utility company. We have excellent healthcare. We pay about $160/month for a high deductible/ low premium plan for our entire family. Our premiums have not increased because of the AHA. Our deductibles have not increased due to AHA. We have Blue Cross/Blue Shield.

 

There has been so much misinformation spread about the AHA. The misinformation is entirely political. When I think about the AHA, I always remember the words of Thomas Jefferson. "We holds these truths to be self evident, tall men are created equal, that they are endowed by their Creator with certain unalienable Rights,, that among these are Life, Liberty, and the pursuit of Happiness." That means something to me. "Life", to me, means we all have a right to adequate healthcare, since we are all Created equal. That means that a 16yo girl should not have to watch her mom (psychotic though the mother is) bleed out on an ER floor because the mom cannot afford insurance. That means that even though, previously, the parents could afford healthcare, the parents of a 12yo girls should not have to file bankruptcy because they could not afford the premiums on their "Cadillac" insurance policy because the mother developed pre-eclampsia.

 

Prematurely raising insurance rates? Greed. Reducing hours worked by employees so you can afford private jets? Greed. The AHA does not require companies to raise premiums. Greed requires that. Evil human nature requires that, not "Obamacare".

 

As I stated before, the law will not affect my professional, Nuclear Engineering Degree husband. Perhaps, by working for a public utility, we are isolated from the greed of major corporations. However, I have no problems paying a little extra in taxes (though we do not make enough to have our tax rate increased) so some other 16yo kid does not have to watch her "pre-existing condition" mom almost bleed out on an ER floor.

[Slartibartfast]

You seem to be unclear on Obamacare. It is not insurance. It is simply a(n unconstitition imo) mandate that YOU purchase insurance, no matter how unaffordable, and no matter how little benefit you actually receive or you will be fined.

 

It does allow for the creation exchanges where people will be able to purchase insurance, and that may be subsidized. It also expands medicare to cover more and pay primary care doctors more.

 

It isn't insurance, but it does vastly expand what insurance can do, cannot do and helps more people get it.

 

Things are so nuts that I read in the paper today that some guy is getting his weekly Testosterone shot covered by his insurance plan, whereas MY crap insurance plan (and spouse is an attorney here - it is hitting all levels of professions/trades) didn't cover a dime on my kid's antibiotic - the one time in five freaking years I needed one for him - so I paid forty dollars cash (and 45 for the appointment at a clinic) after they checked. Nice priorities there. But I don't mind paying for my rare visit and antibiotic, if everyone else would just pay for their own stuff too, so insurance rates would stay reasonable and cover all important stuff, as they always did.

 

My Mom died in the last decade. She rarely visited a doctor in her last few decades of life. Her month long hospital visit for surgery and other problems - totally covered. Her final week stay - totally covered my Medicare and Medigap.

 

Do you think any of us will have this? I don't. By sharp contrast, two days after arriving home, I got an immediate $6,000 bill out of pocket for uncovered costs last year when I was in the hospital for the first time since childhood. Many other bills followed, all under the "good" previous insurance we had. Now the company has moved to the cheaper insurance because of this ruling. The same bill today under new coverage would be in excess of $10,000 immediately upon exiting hospital.

 

Without seeing the actual exchanges, and we cannot see them, it would be impossible to estimate what the differences in care would look like. I do know that one can see estimated out of pocket costs and deductibles before subsidies kick in can be seen on the calculators.

 

It is difficult to really discuss something in the absence of facts and since these programs are not yet available we do not have those facts.

 

 

So...all those people that are thrilled that the yearly well appointment will be covered by increasing the premiums for everyone (because nothing is free) and are happy about their "free" birth control and OB visits will not be so thrilled when they need coverage for something other than the stuff that used to be cheap, like well visits and common drugs.

 

I'd much rather pay for my OWN well appointments, drugs, births, ob-gyn stuff - as I always have - and let the insurance really cover the bigger, more important things that we used to be able to turn in. Now we have to carry some stupid credit card around and if you forget, too bad for you. All out of your own pocket. I can't believe people think that being given the relatively inexpensive well care appointments and birth control in exchange for good coverage of the disastrously expensive specialty care is a worthy exchange.

 

 

But a lot were not paying for those things or are unable to pay.

 

I do want prescriptions on my insurance, while you may not need expensive prescriptions I have been on medications that cost $400 for one month without insurance.

 

http://www.healthcar...vices-list.html

 

http://www.healthcar...n08012011a.html

 

http://www.cdc.gov/m...ml/su6102a8.htm

 

Without seeing actual facts it is difficult to estimate whether or not someone would be thrilled to see their coverage. Those plans are not yet in place.

 

 

 

Kids being on the insurance until 26 is not "free" either. One site said that this adds an extra $3400 a year to the policy, and someone is paying this. All of us are paying this. And they will have the same crap coverage too, if something actually happens. Some will argue that it is better than nothing, and maybe that's true. But if you have "access" to a policy you still can't afford, then government subsidies (meaning everyone else pays) kick in so you can purchase your mandated policy. It may or may not be good insurance, and we are all covering the costs that only those to whom they applied used to have to cover. As a woman, I had to have OB-gyn coverage (which I have almost never used, especially since I had home births), but I didn't have to cover things that didn't apply to me. Now we will all shoulder those costs of all these "free" well checks, vaccines, tests, and birth control, whether or not we agree with doing this, ever need this, or want to cover it.

 

Nice concise blog commentary here:

 

My husband's company has already made that change with little effect. I believe we actually pay about $20 a month since that was changed, we do not have a 18+ year old but that is fine by me.

 

I am startled to read that you oppose that children with pre-existing conditions be covered. The Republicans supported that aspect of the bill.

 

So what are those children supposed to do as they become adults? I hope it is realized that those children would likely end up on disability insurance without the AHA or they would be stuck with using an ER for primary care, which they would be unable to pay for. That is precisely what we do not want. That is exactly the sort of thing that raises rates for everyone. And we would be paying for their insurance anyways, since many of those children would be disabled.

 

My sister works with a woman whose son has Cystic Fibrosis. Now, had a child in my generation been born with CF they would have died in childhood but medical advances have progressed to where many with CF are living much longer.

 

He is unable to work because he will lose his disability insurance. If he tries to work to provide his own insurance he soon becomes exhausted due to his illness and has to go back to disability. He has to use the ER as primary care because he cannot afford primary care.

 

What would you suggest to help these people as they enter adulthood? Because what we have now isn't working and would get worse without the AHA.

 

We can't exactly want all these medical advances and then let the people who benefit from the medical advances die because they cannot afford them, can we?

 

 

How it will help self-insured people: Well, they must get insurance but there is no guarantee that it will be any less expensive than it is now. How is this a benefit?

 

There is no indication yet that it will be more expensive. It is impossible to estimate the benefit without any facts.

 

A study by the CDC shows that more young adults are insured, so I don't know where that information is coming from.

 

http://www.nytimes.c...study-says.html

 

 

The gov't will subsidize those who cannot afford to purchase insurance. But remember, the governmental debt is approaching $16,000,000,000,000 (that's16 trillion ). The gov't will now spend money paying for insurance for those who cannot afford it themselves. So where is that money coming from?

 

There are many taxes in the bill. There is even a tax on tanning in the bill.

 

 

The really unfair part is that those who are young and healthy who could get cheap policies (mine was like $200 a year when I was 21 and purchased my first individual policy), will now have to pay a much higher premium in order to support everyone else's premiums, because it will no longer be based on statistical risks. This benefits me, as an older pre-boomer (to the extent that there is any advantage in rising costs at all), but penalizes young, healthy, working adults. Since ever-rising premiums are entirely unaddressed by this law, many of the young and healthy will choose to pay the tax penalty, rather than unaffordable premiums, and the premiums rise even higher for everyone else who is still buying insurance.

 

There is no indication yet that the premiums will be unaffordable, it is impossible to estimate in the absence of any facts.

 

The most important part to note is that health care costs are entirely UNCONTAINED by the legislation. Winners: Big Pharma and Medical device companies. Losers: everyone else, except for a few individuals, mainly among the extremely low income (who used to just use the ER anyway...so not necessarily much of a change).

 

 

Big Pharma and medical device companies are being taxed by this bill.

 

In the absence of facts it would be impossible to estimate the losers. *shrug*

[[email protected]]

If the discussion stays on "What will my health insurance costs be? How does the law work?" and away from "What X Official and X Party are doing to our country and way of life," the thread will stay open.

[delaney]

Can they raise the rates? Sure but they still have to pay out a certain percentage in claims or they have to do refunds, which you mention receiving. In the long run, this will keep things stable and eventually bring rates down.

Can they raise the rates? Sure but they still have to pay out a certain percentage in claims or they have to do refunds, which you mention receiving. In the long run, this will keep things stable and eventually bring rates down.

 

The insurance company may raise rates on their own out of greed. Nothing to do with the bill. We pay $700 per month and hardly go to the Dr. I would love the option of a basic govt plan for my family but the plan is not there yet. Insurance companies need to be sent a message CLEARLY that cannot continue to hold people hostage with rates. We all deserve basic coverage in the taxes we pay. I would gladly pay $3000 more per year for govt coverage because it is far less than what I pay now. I would like the option to add a premium level to that so that I can access the docs I want when I want. Still cheaper and no one goes without. That is what Australia has and it is what we need. But who has their hand in political pockets? Big pharm and other healthcare companies. THAT is what is wrong with our country. rant over :cursing:

[Murphy101]

But if you pay the penalty, you get no insurance. Whereas if you pay for the coverage, about $2k more a year (or $166 a month), you get insurance for 8 people. Which is $20 a month per person. Which is a pretty darn good rate.

(Ok, it's more like $40 if you add in the penalty, which you'd have to pay whether you got the insurance or not.)

You could easily eat up three to four months worth of premium in one office visit plus a prescription. And if anything serious happens, or even just semi-serious, you're covered. One fairly minor visit to the ER could cost half your yearly premium. And with 6 kids, it's not an unlikely scenario. And better yet, you (not you personally - just an example) wouldn't have to be on the boards saying "should I take this kid in?", you could just go. And a catastrophic event or illness wouldn't bankrupt you. I mean, $4K a YEAR for insurance for EIGHT people? That's a really good price.

 

$4k a year, would be $300+ a month. That's not comparable to now. And it presumes a lot. We have had great difficulty finding decent drs who take our insurance. No problem at all finding good drs who have decided to not take insurance at all. And yes, I would still be asking if I should go. Why wouldn't I? I'd still have a copay and deductible and up to 15% to scrounge up the money for each time. And of course it could still bankrupt us. 15% of the overall cost can be a huge amount of money for most people.

 

We never go to the dr every month but when we do, the cost with insurance is always over $300 a month before insurance kicks in that $300 a month in premiums could go a long ways toward other needs or just toward other medical. And again, you presume our drs would even take that insurance. So I could spend $300 a month towards insurance that may not do much of anything for us or I can pay a penalty that is less. Why wouldn't I pay the penalty?

 

At most, I think we might pay only for dh.

[justasque]

$4k a year, would be $300+ a month. That's not comparable to now. And it presumes a lot. We have had great difficulty finding decent drs who take our insurance. No problem at all finding good drs who have decided to not take insurance at all. And yes, I would still be asking if I should go. Why wouldn't I? I'd still have a copay and deductible and up to 15% to scrounge up the money for each time. And of course it could still bankrupt us. 15% of the overall cost can be a huge amount of money for most people.

 

We never go to the dr every month but when we do, the cost with insurance is always over $300 a month before insurance kicks in that $300 a month in premiums could go a long ways toward other needs or just toward other medical. And again, you presume our drs would even take that insurance. So I could spend $300 a month towards insurance that may not do much of anything for us or I can pay a penalty that is less. Why wouldn't I pay the penalty?

 

At most, I think we might pay only for dh.

 

Martha, I've looked at the numbers again. if there are 10 people in your family, and you make 65 K, according to this calculator you are at 138% of federal poverty level. (Medicaid kicks in at 125%.) Looking at three different calculators (the two posted previously, as well as this one, and extrapolating for the number of people in your family, it seems like your subsidized rate is likely to be $1400-$2000 or even less. That's $117-$167 per month for 10 people, or $12-17 per month per person. That's about the same amount (or less) than the penalty tax would be. Your max out-of-pocket per year would be $4000; less if you don't use the doc as much. The rate goes down as household size goes up, so paying for only your dh probably wouldn't make financial sense.

 

Yes, of course in most cases you'd think about whether you should go to the doc - for everyday things like a bad cold. That's why plans have deductibles and co-pays - to encourage folks not to go overboard. But for serious injury or illness (which is what I had in mind - we see way too many of these questions on the Hive), you could just GO.

 

The most you'd pay in a year, for premiums plus out of pocket, is $5400-$6000. It's a lot, but one ER visit could eat that in one gulp. And with 8 kids, an ER visit isn't unlikely. Annual check-ups alone would be around $1000 for 10 people. Even if you eat right, get plenty of exercise, and take safety precautions, you are still vulnerable to drunk drivers, cancers, premature babies, and other scenarios that hit more-or-less randomly.

 

Look, health insurance can go one of two ways -

You could end the year financially better off because one of your kids got seriously ill or injured and you ended up getting way more out of it than you paid in.

Or you could end up with healthy kids, with your premiums going to someone else whose kid is seriously ill or injured, instead of to you.

 

Honestly, my ideal scenario is the second. And at less than twenty bucks a person per month, it's a bargain to have that peace of mind.

[Murphy101]

Yes, of course in most cases you'd think about whether you should go to the doc - for everyday things like a bad cold. That's why plans have deductibles and co-pays - to encourage folks not to go overboard. But for serious injury or illness (which is what I had in mind - we see way too many of these questions on the Hive), you could just GO.

 

It doesn't matter what the issue is, if someone doesn't have the money, they don't have the money. Of course I would question whether it is serious enough to go same as I do now. How serious it is doesn't change how much money I have to begin with.

 

The most you'd pay in a year, for premiums plus out of pocket, is $5400-$6000. It's a lot, but

 

But nothing. Again, that's a lot of money. Period. If someone can't afford it, it doesn't matter whether it is a good deal or not. How good a deal someone else thinks it is does not change how much money I have.

 

Look, health insurance can go one of two ways -

You could end the year financially better off because one of your kids got seriously ill or injured and you ended up getting way more out of it than you paid in.

 

Well that's never happened. Usually what happens is someone gets really sick and runs up a huge medical bill from hell and the insurance decided to not pay, not pay much, take forever to pay, only pays for crap services when we need to use better options...

 

Or you could end up with healthy kids, with your premiums going to someone else whose kid is seriously ill or injured, instead of to you.

Honestly, my ideal scenario is the second. And at less than twenty bucks a person per month, it's a bargain to have that peace of mind.

 

Yeah. Not a fan of robbing Peter to pay Paul either. :/

 

And you still don't address the problem of finding covered drs. None of our current providers are accept insurance or plan to do so. And the providers on our insurance either suck or have such a huge patent load that it's near impossible to get in to be seen. Dh has to schedule his endocrinologist appointments 4 months in advance.

[ssexton]

that's about what we pay. actually, wait. we're more like 10% now.

 

 

We are at 13.4%. Dh works for a small firm that doesn't offer insurance. We buy our own private plan.

[justasque]

...Usually what happens is someone gets really sick and runs up a huge medical bill from hell and the insurance decided to not pay, not pay much, take forever to pay, only pays for crap services when we need to use better options...

...

And you still don't address the problem of finding covered drs. None of our current providers are accept insurance or plan to do so. And the providers on our insurance either suck or have such a huge patent load that it's near impossible to get in to be seen. Dh has to schedule his endocrinologist appointments 4 months in advance.

 

 

Martha, I'm sorry you have such horrid insurance. :grouphug: It shouldn't be that way.

 

I don't have any magic answers for you, I just was curious and ran the numbers based on your info.

$65K is a decent income, but add in 8 kids and it's got to stretch a very long way.

You will get a substantial subsidy on your premiums, but I don't know if you will be better off with one of the new insurance choices, or not. I hope, either way, you, your hubby, and your kids stay healthy and don't need it.

 

In the end, health care just doesn't come cheap.

[Mrs Mungo]

I just wanted to say thanks to all that have contributed to this thread. I have learned a lot

 

If someone has to be subsidized, where does that money come from specifically? Has that been identified? Does anyone know what the increase in tax would be to the people for the AHA?

 

 

 

 

• A new excise tax on high-premium insurance (Cadillac) plans, equal to 40 percent of premiums paid on plans costing more than $27,500 annually for a family, starting in 2018

• An increase in Medicare payroll taxes on couples with income of more than $250,000 a year

• Unearned income, like capital gains, subject to additional 3.8 percent tax

• Customers of indoor tanning salons would pay a 10 percent tax

• Fees on insurance companies, pharmaceutical companies and medical device manufacturers, including $33 billion over 10 years on fees on drug makers, starting in 2014

• A tax on individuals without qualifying coverage, maximum penalty set at 2.5 percent of income

 

[FaithManor]

I would like to state that while a previous person felt that reduced work hours, or lay offs are all a result of greed this is not so in many, many cases. Yes, there are HUGE companies whose profit margins are so large that their major stock holders and upper management would NEVER notice the cost of healthcare if they were normal human beings that didn't worry about whether or not last year's stock options' package was 30 million and this year it is only 29 million! However, because we hear about those kinds of companies on the news a LOT, we tend to think of all business as BIG business.

 

The reality is that 65% of Americans are employed by smaller businesses with very modest profit margins, tiny lines of credit, and deeply hurt in this economy. Three local companies that employee in the range of 53-55 people each only "made" (net-profit after expenses) less than $100,000.00 last year. They paid an exhorbitant state income tax rate on that because Michigan is the supreme small business tax state since they've give so many UNGODLY tax perks to large corporations that they would not be taking in much at all in business income taxes without looting and pillaging small businesses. Last year Detroit Edison netted $754 million in profits and did not pay one blessed cent in state income tax! There was an article about this in the local newspaper because three area small businesses are going bankrupt this year because they will no longer be able to turn a profit and yet were paying a mind boggling amount of tax...don't start me on liability insurance...that one is a killer for many small business owners!

 

In contrast, my dad an employer of eleven people, had a business profit of a whomping $32,000 (this goes back into the business for the next year to replace worn out tools, vehicles,etc.) for working with my mom a combined average of 115 hours per week and incuring all of the stress and risk that goes with owning a business. On that piddly profit, the business paid $8,000 out in income tax. While dad will not be required to offer medical insurance (something that can not be purchased on eleven families for the $32,000 that was left after last year's expenses - oh, and my parents only take a combined salary of $29,000.00 out in payroll for their angst and hardwork), he will probably go out of business due to the legislation anyway. The Michigan legislature, since it made these 10 and 20 year deals with GM, Ford, Chrysler, DTE, HP, Pharma companies, etc. that preclude any of them contributing a dime to the treasury for a good, long time, intends on raising taxes on small business again and increasing the costs of technical licensing. The boiler license for wood/propane, etc. installers will be more than $5000.00 each year. The mechanical license is going up as is the electrical and plumbing all of which dad needs in order to run his businees. Combined with increased taxes and licensing costs, he'll be in the red and no line of credit from the bank to help him over the hump assuming that the economy would improve in the next year or two and he could return to profitability. Additionally, since he can't provide health insurance, his employees are insisting that he increase their wages to cover the penalty since none of them are planning on purchasing insurance. On eleven people, this alone would push the business into the red.

 

So, the doors will be closing after the first of the year. Dad is losing everything because the economy has been so bad that he will lose the building, vehicles, etc. to the bank to pay off the last line of credit he needed when a bunch of building codes changed and he had to upgrade the buildings without any working capitol to do so. Eleven people will be out of work and my mom is going to end up working part-time at Walmart to try to make ends meet. Dad will be doing some repairs and carpentry out of the house for some extra cash since their 401K took a massive beating and has never really recovered.

 

Not everyone who says they'll have to fire employees, scale back the business, or close their doors over healthcare is bluffing, whining, complaining, or greedy. I really take issue with that assumption. This nation has a 16 trillion dollar debt and someone has to pay for all of this. I can guarantee you that the fat cat companies that make their million dollar campaign contributions in exchange for tax loopholes, exemptions, right offs, and total tax forgiveness will not be funding this legislation.

 

I'm all for healthcare for everyone. I am not for this particular answer to healthcare.

 

As for what our healthcare costs us, we pay 14% of income for ours and dh works for a very large company. We have BCBS, but it's a special policy negotiated by his employer for Michigan employees. It's a PPO and just about NO ONE in our area takes it and that includes hospitals. So, we are scared to death to even attempt to use it. The number of exclusions and "won't pay" and out-of-pockets is such that even with insurance, if one of us ever had anything really major happen, we'd go bankrupt anyway. When dh had Lymes, we drove 85 miles to a specialist in Detroit (great Doc by the way) for treatment because we couldn't get anyone locally to see us. We won't have access to any more healthcare than we have now. So, like many people in our area, we have insurance that would hypothetically cover healthcare expenses or at least a portion, but no doctors or hospitals that accept the insurance. If you make enough money and have enough time that you can afford 170 mile trips every time you need to see a doc, another trip for labs, another for.....then you might be okay with your legislated insurance plan. But so far, going through the options that my uninsured niece and mother of one child will have, we haven't seen any that will cover healthcare within 30 miles of her home. Her car is on it's last leg and she waitresses a mind-boggling number of hours each week in order to keep her head above water. She can't haul a sick kid to the city for healthcare.

 

Just because the legislation provides that everyone get insurance, this does not mean for one instance that everyone will actually have healthcare because of it. Until this culture sees healthcare as a moral imperative and chooses to fund it separately from employment and REMOVES big business, big pharma from the driver's seat and puts the healthcare professionals back in charge, things really won't change much. It will all be more of the same crappy and cost a lot more money to provide so very little.

 

Anyway, that's my two cents.

 

Faith

[astrid]

Well, two responses to this:

 

Obama himself said he had grown fond of the term.

 

I cannot call it the "Affordable" Health Care Act. It makes NOTHING affordable; it doesn't begin to even approach the problem of exponentially rising costs. EVERYTHING will be more expensive to support the bloated infrastructure and the hundreds of IRS Agents to hunt you down if you don't pay.

I just can't do that with a straight face.

 

 

You can call it whatever you like. I was merely pointing out the fact that the name of the act is not "Obamacare." It is the Affordable Health Care Act. Personally, myself and many others call this a welcome step toward health care reform.

 

astrid

[nmoira]

 

[*]A new excise tax on high-premium insurance (Cadillac) plans, equal to 40 percent of premiums paid on plans costing more than $27,500 annually for a family, starting in 2018

 

 

Is that the only criteria? Our plan through DH's work is currently considered a Cadillac plan, but while the coverage is very good, it's not quite Canada. :) I'm a bit worried about what changes they'll make to de-Cadillac it.

[nmoira]

 

 

I looked up what a Cadillac plan is and who pays the tax. Here is a slightly aged article that explains. I thought the families would have to pay the tax but this says that the insurance companies pay the tax. I have no idea if we have a Cadillac plan or not. I don't know what dh's employer pays into our policy only what we pay.

 

http://www.slate.com/articles/news_and_politics/explainer/2009/10/do_i_have_a_cadillac_plan.html

 

Thank you Mrs. Mungo for your added info.

 

 

Thanks. That article had the tidbit I'd been missing: the tax is only on expenses above the cutoff, and not the entire package.

[CAMom]

I cannot believe I am wading into this discussion, but it is late, my husband is not home, and I have insomnia.

 

 

There has been so much misinformation spread about the AHA. The misinformation is entirely political. When I think about the AHA, I always remember the words of Thomas Jefferson. "We holds these truths to be self evident, tall men are created equal, that they are endowed by their Creator with certain unalienable Rights,, that among these are Life, Liberty, and the pursuit of Happiness." That means something to me. "Life", to me, means we all have a right to adequate healthcare, since we are all Created equal.

 

I'm wondering.....not debating just wondering.....

 

Do we change this idea as time goes on? You said that the words of Jefferson mean that we all have a right to adequate healthcare but there really wasn't such a thing as insurance and affordable health care at the time that was written.

 

So, how do we tell what it encompasses? Do we stick to what the writer meant or do we make it up as we go along?

 

Again, not debating. Just something I've wondered for awhile. :)

[CAMom]

Very small companies who pay for employee healthcare can receive subsidies once the exchanges kick in. That is in the bill.

 

 

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http://www.healthcar....html#taxcredit

 

 

But, I don't want to take advantage of subsidies. I don't want the burden of insuring my guys to fall in the laps of other tax payers.

[Random]

I looked up what a Cadillac plan is and who pays the tax. Here is a slightly aged article that explains. I thought the families would have to pay the tax but this says that the insurance companies pay the tax. I have no idea if we have a Cadillac plan or not. I don't know what dh's employer pays into our policy only what we pay.

 

http://www.slate.com...illac_plan.html

 

Thank you Mrs. Mungo for your added info.

 

I'm entering this discussion late, but I'd like to say that companies never, ever actually 'pay' the tax. It is (as much as I can tell) 100% of the time, passed along to the consumer. Especially an insurance company....you can bet your bottom dollar they *will* remain profitable. Period. This is important.

[LisaKinVA]

The AHA reduced the amount we can put aside in our Flexible Spending Account (like a health care savings account). This money is for medical expenses not paid for by insurance. We used to be able to set aside $5,000 a year, beginning 2013 it will be capped at $2,500 (that's for our entire family of 7, not per person). This is money we used to use for my dental work, the kids' braces, glasses/contact lenses...and paying for home birth of our children (which isn't covered by our insurance... at all... of course they will pay 100% for a hospital birth that costs roughly 3x the amount here).

 

The AHA increased the amount you must spend OOP before you can deduct it from your taxes, it used to by 7% and beginning in 2013, it will be 10%

 

Stuff that wasn't covered by our insurance before will still not be covered.

 

Our insurance premiums went up nearly 30%. I guess they had some catching up to do..

 

So, from our perspective, the AHA will increase our taxable income, and in essence have us spend more OOP each year. I still have $11,000 of dental work to finish. I have one son starting in braces Dec. 11, and 5 behind him...we have four in glasses, and in need of vision care. And, this doesn't include work that I know is coming (dd 4 has 2 of her front teeth that came in facing each other...dd 6 has an extra tooth that has attached to another primary tooth, that will need to be pulled). Almost all of this work will be paid OOP, We used to be able to space stuff out, and took full advantage of our FSA.

 

Lisa

[QueenCat]

I'm entering this discussion late, but I'd like to say that companies never, ever actually 'pay' the tax. It is (as much as I can tell) 100% of the time, passed along to the consumer. Especially an insurance company....you can bet your bottom dollar they *will* remain profitable. Period. This is important.

 

With the Affordable Health Care Act, they must pay out 80% of what they take in from premiums. Of course they'll remain profitable, they are businesses. They'd have no reason to exist as private entities if they were not allowed to make a profit. This section of the law keeps the percentage of profit "in check".

[TXMomof4]

The AHA reduced the amount we can put aside in our Flexible Spending Account (like a health care savings account). This money is for medical expenses not paid for by insurance. We used to be able to set aside $5,000 a year, beginning 2013 it will be capped at $2,500 (that's for our entire family of 7, not per person). This is money we used to use for my dental work, the kids' braces, glasses/contact lenses...and paying for home birth of our children (which isn't covered by our insurance... at all... of course they will pay 100% for a hospital birth that costs roughly 3x the amount here).

 

The AHA increased the amount you must spend OOP before you can deduct it from your taxes, it used to by 7% and beginning in 2013, it will be 10%

 

Stuff that wasn't covered by our insurance before will still not be covered.

 

Our insurance premiums went up nearly 30%. I guess they had some catching up to do..

 

So, from our perspective, the AHA will increase our taxable income, and in essence have us spend more OOP each year. I still have $11,000 of dental work to finish. I have one son starting in braces Dec. 11, and 5 behind him...we have four in glasses, and in need of vision care. And, this doesn't include work that I know is coming (dd 4 has 2 of her front teeth that came in facing each other...dd 6 has an extra tooth that has attached to another primary tooth, that will need to be pulled). Almost all of this work will be paid OOP, We used to be able to space stuff out, and took full advantage of our FSA.

 

Lisa

Is the FSA amount per family or per person? That doesn't make any sense at all to me to reduce that amount. I've got 3 coming up to braces in the next 2 years and I was looking forward to a little bit of a tax break putting the money in a FSA.