rdenny wrote:BTW, read Roberts opinion in full. Please do not assume I did not because my interpretation differs from yours. I certainly respect your right to have differing opinion from mine. Certainly constitutional and legal interpretation is not black and white.

In this case, it is black and white. Read it!

Wurble wrote: http://www.kff.org/healthreform/upload/7962-02.pdf

Thank you. That's much more helpful that what I first read but still rather complicated.

AmirMortal wrote:They can't turn you down for coverage anymore, but they can charge you as much as they please.

The amount that you pay yearly in premiums, deductibles, copays is capped depending on how much above the poverty level you are.

lemur wrote:

AmirMortal wrote:They can't turn you down for coverage anymore, but they can charge you as much as they please.

The amount that you pay yearly in premiums, deductibles, copays is capped depending on how much above the poverty level you are.

Got a link? I still haven't seen a breakdown, and I keep hearing very different things.

AmirMortal wrote:

lemur wrote:

AmirMortal wrote:They can't turn you down for coverage anymore, but they can charge you as much as they please.

The amount that you pay yearly in premiums, deductibles, copays is capped depending on how much above the poverty level you are.

Got a link? I still haven't seen a breakdown, and I keep hearing very different things.

Wurble posted this earlier:

http://www.kff.org/healthreform/upload/7962-02.pdf

I also found this site:

http://101.communitycatalyst.org/aca_provisions

As for getting different stories from different people, I'm not surprised. Many individuals take the saying "everybody is entitled to their own opinion" as a license to utter pronouncements about things they are not informed about. But even informed people can give different stories since the impact varies depending on each people's own situation. I read a government study earlier (but which I no longer have a URL for) which talked about how some people will pay more under the new system and some will pay less.

lemur wrote:

rdenny wrote:BTW, read Roberts opinion in full. Please do not assume I did not because my interpretation differs from yours. I certainly respect your right to have differing opinion from mine. Certainly constitutional and legal interpretation is not black and white.

In this case, it is black and white. Read it!

Thanks for your input. Please read Ginsburg's concurrence. Apparently she felt the issue was not so black and white and relied on Wickard in her reasoning. “It is well established by decisions of this Court that the power to regulate commerce includes the power to regulate the prices at which commodities in that commerce are dealt in and practices affecting such prices.” citing Wickard at 128. In Wickard this included the decision not to participate in the wheat market by growing wheat for personal consumption.

"Rather than evaluating the constitutionality of the minimum coverage provision in the manner established by our precedents, THE CHIEF JUSTICE relies on a newly minted constitutional doctrine." (Ginsburg, concurring). Ginsburg apparently felt precedent existed to uphold the mandate under the commerce clause.

Again, please do not assume I have not read something if my opinion differs from yours. I will readily admit I have only read the mandate section of Ginsburg's concurrence and Roberts full opinion of the court. Still working on the rest of Ginsburg's opinion and the dissent.

Also, what about the rumors Roberts wrote the majority of the dissent before changing his vote at the 11th hour? Only heard grumblings of it. Any thoughts?

rdenny wrote: Thanks for your input. Please read Ginsburg's concurrence.

Ginsburg's opinion, being in the minority, is moot.

lemur wrote:

rdenny wrote: Thanks for your input. Please read Ginsburg's concurrence.

Ginsburg's opinion, being in the minority, is moot.

thanks for your opinion.

AmirMortal wrote:I don't mind paying the extra tax, but the problem for me is that I won't likely actually see a benefit. I could be wrong, and time will tell, but as far as I know all that this bill does for me is allows me to have a pre existing condition. There is no mandate for the costs to actually be "affordable". They've still got me over a barrel in that the insurance companies still make up their prices as they go. It does make for a nice name though.

I would be happy to pay an extra 3-5 percent, if I and my family got full coverage, but as long as the for profit corporations dominate and control the costs, that is very unlikely. They can't turn you down for coverage anymore, but they can charge you as much as they please.

Please read the link. It doesn't matter if insurance companies make their premiums expensive because there is a tax credit which scales such that there will be a maximum out of pocket for premiums based on income. The credit is for everyone up to 400% of the FPR. The current FPR is something like $10,800 for a single person and like $20,000 for married couples or something. So for single folks up to $40 grand and married couple up to $80 grand, there will be tax credits there to ensure a maximum insurance premium.

If you are making more than $40,000 a year, then I think you can probably afford it. If you still can't, then you can afford to take the added tax.

Wurble wrote: It doesn't matter if insurance companies make their premiums expensive because there is a tax credit which scales such that there will be a maximum out of pocket for premiums based on income.

Yes, and the insurance market also remains a market. If a company decides to jack up their prices because of government subsidy, they are pricing themselves out of the market.

What about collusion? Well, they'll be able to do that under the ACA to the exact same extent that they can do it now.

At the end of the day I'd still prefer a single payer system.

My wife is cracking up over the misinformation about the ACA. She got training on the changes and when they go into effect before she left the non-profit she was volunteering for.

There is a max that insurance companies can charge under teh law, but that doesn't go into effect until 2014. Until then, its whatever they can fleece from their policy holders...

ErikO wrote:My wife is cracking up over the misinformation about the ACA. She got training on the changes and when they go into effect before she left the non-profit she was volunteering for.

There is a max that insurance companies can charge under teh law, but that doesn't go into effect until 2014. Until then, its whatever they can fleece from their policy holders...

Just a better argument for getting the insurance companies out of healthcare. You can only depend on capitalists to do one thing--- "make" money. They don't have morals. They don't have honor. They don't have compassion. They accumulate whatever money they can, in whatever manner they can.

ErikO wrote:My wife is cracking up over the misinformation about the ACA. She got training on the changes and when they go into effect before she left the non-profit she was volunteering for.

There is a max that insurance companies can charge under teh law, but that doesn't go into effect until 2014. Until then, its whatever they can fleece from their policy holders...

I'm not sure how to construe what you are writing here.

What companies won't be able to do from 2014 onwards is determine difference in premiums on the basis of prohibited criteria. There is a series of factors that companies won't be allowed to use anymore, but I've not found any source stating that there will be an absolute cap what premium they may charge.

So company A could set their annual baseline for determining premiums at $5000 and company B could set it at $10,000. That's all legal as long as they do not compute a final premium on the basis on prohibited criteria.

Let's assume that Alice, Bob, Bill and Caroline are all in the same situation, except for differences stated below.

Company A could set Bill's premium at $5200 and company B could set it at $10,000.

Company A and B could not set Bob's premium to twice Bill's because Bob had a heart attack.

Company A and B could not set Caroline's premium to twice Bill's because she's a woman.

On the other hand, if Alice is smoking, both companies can set her premium up to 1.5 times what they charge Caroline, Bob or Bill. (Yep, the law has a provision for smoking which says 1.5 higher maximum.)

Some of the information out there is misleading because it talks about a "maximum premium" but that does not refer to the maximum premium a plan may charge in absolute terms but to amounts someone may have to pay once the government subsidy kicks in. And this is the thing: the government subsidy is capped. If Bill decides to go with the $10,000 plan he's going to have to pay the difference.

I'm not claiming I read the whole act so if someone has a reference to an absolute maximum premium that companies won't be able to go over, please cite.

Insurance companies will come up with some high deductible minimum coverage just to keep you legal like they do for auto insurance.

Paladin wrote:Insurance companies will come up with some high deductible minimum coverage just to keep you legal like they do for auto insurance.

I'm sure that such insurances will be around but the ACA also establishes a cap on annual out-of-pocket expenses that people are expected to pay. The out-of-pocket expenses include premiums, deductibles and copays.

Like premium calculations, the maximum out-of-pocket expenses are subsidized depending on revenue.

lemur wrote:

ErikO wrote:My wife is cracking up over the misinformation about the ACA. She got training on the changes and when they go into effect before she left the non-profit she was volunteering for.

There is a max that insurance companies can charge under teh law, but that doesn't go into effect until 2014. Until then, its whatever they can fleece from their policy holders...

Some of the information out there is misleading because it talks about a "maximum premium" but that does not refer to the maximum premium a plan may charge in absolute terms but to amounts someone may have to pay once the government subsidy kicks in. And this is the thing: the government subsidy is capped. If Bill decides to go with the $10,000 plan he's going to have to pay the difference.

I'm not claiming I read the whole act so if someone has a reference to an absolute maximum premium that companies won't be able to go over, please cite.

The subsidy is based on certain plan criteria. Each insurance company must have at least one plan which meets that criteria. Let's call the plan, Plan A.

Let's say Plan A is $8000 a year. Let's say Bob makes $13000 a year. That means Bob's maximum out premium payment per year for Plan A is $260. Bob will get a subsidy of $7740. Let's say Bob wants Plan B instead. Let's say Plan B is $9000. Bob will still get a subsidy of $7740, so that plan will wind up costing him $1260.

The subsidy is based on these "basic" plans and your personal income. In the example above, no matter how expensive Plan A is, Bob would only have to pay $260 for it. End of story there. The insurance company could charge $50,000 a year for it, Bob would still pay $260 because the subsidy is based on Bob's income and Plan A's premium. All non-basic plans however will get Bob the same exact subsidy amount, so any price difference between those plans and Plan A is out of Bob's pocket.

As for a "cap" on the subsidy, there isn't one. There is theoretically no limit to how much you could get back. How much you get back is based on your income and the premium of the "basic" plan. There is however a cap on the income that qualifies for the subsidy. That cap is 400% of the FPR. The percentage out of pocket expected though is a sliding scale up to that point though. It starts at 2% for everything up to 133% of the FPR and goes up to something like 9.5% for those who are 400% of the FPR. Beyond 400% of the FPR, you get no subsidy.

Wurble, I agree with most of what you wrote but an explanation is in order.

Wurble wrote: As for a "cap" on the subsidy, there isn't one.

From the document you posted, first page:

The amount of the tax credit that a person can receive is based on the premium for the second lowest cost silver plan in
the exchange and area where the person is eligible to purchase coverage.

This is what I call the cap on subsidy. This puts an upper limit on the subsidy ("tax credit") anybody can get irrespective of what plan they actually decide to buy. It does not matter if their plan is bronze, silver, gold or platinum (to use the language of the ACA). If Bob decides to take the most expensive "silver" plan, the subsidy is still based on the 2nd lowest cost silver plan... etc... Bob has to pay the difference.

What I was highlighting is that I've seen explanations of the ACA use this criterion, make nice little tables and then label the columns "maximum premium", leaving some to think that maybe the law dictates an absolute premium companies may not go over.

Just saw this...

wlewisiii wrote:Just saw this...

............................................................................. okay you know what, fuck it, the only reason i don't move to canada is because i'm lazy and I have family here.

Canada's too damned cold.


OK, so I just did some minor calculations. Last year I made more $$than I've made sine. '06: 32k. Going by the link posted, that puts me right about $300/mo before taking my smoking into account, which bumps it up to $450/mo. At this point in my life, that means no car payment or car insurance. It's not that I don't want to pay, it's just not in my budget, and that's before taking copays into the equation.

That means bankruptcy. It's very easy for these folks in Congress, who make what, in the neighborhood of $300k just from their part time job, to decide that 10% is "reasonable", but for those of us who work for a fucking living and actually have to live within our existing budgets (meaning we can't just vote ourselves a raise, or take bribes from lobbyists) it's not so easy. I can't just decide to make an extra few hundred thousand dollars. I can bust my ass and maybe make a couple extra grand, but it' not gonna be the extra cash to cover my new expense.

Even if the cost of all of this were completely offset by the tax credit, in theory I'd still have to cough up the fees throughout the year, then hopefully recover them at tax time. Either way, I'm out of luck, in that I lack the Capitol to cover the expense until that point. So we're right back where we started: I can't afford health care.

AmirMortal wrote:Canada's too damned cold.


OK, so I just did some minor calculations. Last year I made more $$than I've made sine. '06: 32k. Going by the link posted, that puts me right about $300/mo before taking my smoking into account, which bumps it up to $450/mo. At this point in my life, that means no car payment or car insurance. It's not that I don't want to pay, it's just not in my budget, and that's before taking copays into the equation.

That means bankruptcy. It's very easy for these folks in Congress, who make what, in the neighborhood of $300k just from their part time job, to decide that 10% is "reasonable", but for those of us who work for a fucking living and actually have to live within our existing budgets (meaning we can't just vote ourselves a raise, or take bribes from lobbyists) it's not so easy. I can't just decide to make an extra few hundred thousand dollars. I can bust my ass and maybe make a couple extra grand, but it' not gonna be the extra cash to cover my new expense.

Even if the cost of all of this were completely offset by the tax credit, in theory I'd still have to cough up the fees throughout the year, then hopefully recover them at tax time. Either way, I'm out of luck, in that I lack the Capitol to cover the expense until that point. So we're right back where we started: I can't afford health care.

two words, single-payer.

gendoikari87 wrote:

AmirMortal wrote:Canada's too damned cold.


OK, so I just did some minor calculations. Last year I made more $$than I've made sine. '06: 32k. Going by the link posted, that puts me right about $300/mo before taking my smoking into account, which bumps it up to $450/mo. At this point in my life, that means no car payment or car insurance. It's not that I don't want to pay, it's just not in my budget, and that's before taking copays into the equation.

That means bankruptcy. It's very easy for these folks in Congress, who make what, in the neighborhood of $300k just from their part time job, to decide that 10% is "reasonable", but for those of us who work for a fucking living and actually have to live within our existing budgets (meaning we can't just vote ourselves a raise, or take bribes from lobbyists) it's not so easy. I can't just decide to make an extra few hundred thousand dollars. I can bust my ass and maybe make a couple extra grand, but it' not gonna be the extra cash to cover my new expense.

Even if the cost of all of this were completely offset by the tax credit, in theory I'd still have to cough up the fees throughout the year, then hopefully recover them at tax time. Either way, I'm out of luck, in that I lack the Capitol to cover the expense until that point. So we're right back where we started: I can't afford health care.

two words, single-payer.

Two words:

STOP SMOKING

I'm sorry, but it's you're own fracking fault when it comes to smoking. That's a choice, a dumb choice, with lots of consequences. One of them is that it costs a buttload. Either accept those consequences, or stop smoking.

Nice, but non-sequitur. Even if I didn't smoke, that's still 300 bucks I don't have every month.

Also, easier said than done.

AmirMortal wrote: OK, so I just did some minor calculations. Last year I made more $$than I've made sine. '06: 32k. Going by the link posted, that puts me right about $300/mo before taking my smoking into account, which bumps it up to $450/mo. At this point in my life, that means no car payment or car insurance. It's not that I don't want to pay, it's just not in my budget, and that's before taking copays into the equation.

I get different numbers. I'm not getting into this to be contrary but because I want to understand how the damn thing works. I figure multiple eyes can double check my calculations and my understanding of the law.

2012 poverty guideline 1 person family: $11,170

32,000 is 286% of the poverty guideline, which corresponds to the 8.05-9.5% bracket. The actual percentage you pay varies linearly within the bracket:

(286 - 200) / (300-200) * (9.5 - 8.05) + 8.05 = 9.30%

9.30% * 32,000 = 2976 yearly or 248 per month.

Now, this is not the final figure you'll pay. This figure is used to determine how much the government will subsidize your premium and they do this by looking at how much the silver plan with the second lowest premium would charge you in the area you live in. However, this charge excludes possible 1.5 surcharge the plan may require. In other words, the calculation is based on you not smoking. (Note that this 1.5 time charge is something the plan may do. They are not required to charge it. More on that later.)

The KFF calculator (here: http://healthreform.kff.org/SubsidyCalculator.aspx) suggest a $3,440 premium for someone who is 30 year old and lives in an average area in terms of health costs. Note that this is a 2014 number but so far we've worked with 2012 numbers. (By the way, I think there is a bug in their calculator.)

3440 - 2976 = $464 per year.

This is the number which is pegged for you: $464. This is the government subsidy you are eligible for. If you go with a plan which costs less than the silver plan with a 2nd lowest premium in your market, then you will pay less than $248 per month. By definition, there is at least one silver plan which costs lest than the one used to determine your subsidy. Then there are also the bronze plans which should cost less than the silver plans but provide also less. If you go with a plan which costs more, you will pay more than $248.

Ok, this was all assuming you do not smoke but you do, in fact, smoke. Let's assume again the $3440 figure and assume that those guys do take full advantage of the 1.5 times surcharge, you'd pay 5160 yearly. Your subsidy remains the same. So,

5160 - 464 = 4696 yearly or $391.33 a month.

AmirMortal wrote: Even if the cost of all of this were completely offset by the tax credit, in theory I'd still have to cough up the fees throughout the year, then hopefully recover them at tax time.

The subsidy is advanceable, meaning that they can give you the money ahead of time.

AmirMortal wrote: Either way, I'm out of luck, in that I lack the Capitol to cover the expense until that point. So we're right back where we started: I can't afford health care.

How do you manage now? I'm not saying this to be glib. What I'd like is health care for everyone.

AmirMortal wrote:Nice, but non-sequitur. Even if I didn't smoke, that's still 300 bucks I don't have every month.

Also, easier said than done.

actually how much a month do you smoke? you could quit, and put that money to insurance.