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Thu Jun 28, 2012, 01:29 PM

ACA: What Happens If You Don't Get Insurance, Pay The Penalty Tax, And Then Get Sick?

Are all of your health expenses now out of pocket, or do you get some kind of coverage/offset because you paid a "health tax?"

Suppose you come down with cancer. Do you go out and buy insurance at the point you're diagnosed, or do you just go in for treatments and expect that your expenses are covered by the money paid by the large pool of those with insurance?

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Reply ACA: What Happens If You Don't Get Insurance, Pay The Penalty Tax, And Then Get Sick? (Original post)
stopbush Jun 2012 OP
elleng Jun 2012 #1
B2G Jun 2012 #10
Tracer Jun 2012 #39
shraby Jun 2012 #60
Tracer Jun 2012 #62
Sgent Jul 2012 #117
NNN0LHI Jun 2012 #42
pipoman Jun 2012 #102
NNN0LHI Jun 2012 #112
pipoman Jul 2012 #116
TheWraith Jun 2012 #77
Ruby the Liberal Jun 2012 #89
cbdo2007 Jun 2012 #2
Downwinder Jun 2012 #3
snooper2 Jun 2012 #4
4th law of robotics Jun 2012 #14
snooper2 Jun 2012 #15
4th law of robotics Jun 2012 #17
Hoyt Jun 2012 #27
4th law of robotics Jun 2012 #90
Hoyt Jun 2012 #98
4th law of robotics Jun 2012 #100
Hoyt Jun 2012 #103
progressivebydesign Jun 2012 #45
BlueCheese Jun 2012 #52
4th law of robotics Jun 2012 #86
ancianita Jun 2012 #50
4th law of robotics Jun 2012 #87
Wait Wut Jun 2012 #56
Dokkie Jun 2012 #63
Wait Wut Jun 2012 #75
Warren Stupidity Jun 2012 #79
4th law of robotics Jun 2012 #88
doc03 Jun 2012 #43
stopbush Jun 2012 #83
soccer1 Jun 2012 #101
kestrel91316 Jun 2012 #5
4th law of robotics Jun 2012 #16
Hoyt Jun 2012 #28
kestrel91316 Jun 2012 #49
Hoyt Jun 2012 #53
4th law of robotics Jun 2012 #93
Hoyt Jun 2012 #99
B2G Jun 2012 #107
kestrel91316 Jun 2012 #48
BlueCheese Jun 2012 #55
kestrel91316 Jun 2012 #59
BlueCheese Jun 2012 #67
HALO141 Jun 2012 #66
4th law of robotics Jun 2012 #94
ellenfl Jun 2012 #111
4th law of robotics Jun 2012 #115
sunwyn Jun 2012 #6
sinkingfeeling Jun 2012 #7
bornskeptic Jun 2012 #32
Latichever Jun 2012 #8
alcibiades_mystery Jun 2012 #9
alcibiades_mystery Jun 2012 #11
B2G Jun 2012 #13
RagAss Jun 2012 #19
B2G Jun 2012 #21
Hoyt Jun 2012 #68
Ruby the Liberal Jun 2012 #96
BlueCheese Jun 2012 #22
RagAss Jun 2012 #25
Zalatix Jun 2012 #33
B2G Jun 2012 #34
Zalatix Jun 2012 #46
rhett o rick Jun 2012 #58
Ruby the Liberal Jun 2012 #95
kestrel91316 Jun 2012 #51
Romulox Jun 2012 #12
BlueCheese Jun 2012 #18
B2G Jun 2012 #20
BlueCheese Jun 2012 #23
B2G Jun 2012 #24
Hoyt Jun 2012 #29
Uncle Joe Jun 2012 #36
Hoyt Jun 2012 #47
kelly1mm Jun 2012 #54
Uncle Joe Jun 2012 #61
girl gone mad Jun 2012 #70
Hoyt Jun 2012 #71
girl gone mad Jun 2012 #74
Hoyt Jun 2012 #76
nadinbrzezinski Jun 2012 #106
Uncle Joe Jun 2012 #26
treestar Jun 2012 #72
BlueCheese Jun 2012 #84
DesMoinesDem Jun 2012 #82
BlueCheese Jun 2012 #85
4th law of robotics Jun 2012 #91
patricia92243 Jun 2012 #30
B2G Jun 2012 #31
Avalux Jun 2012 #35
B2G Jun 2012 #41
Avalux Jun 2012 #44
4th law of robotics Jun 2012 #92
treestar Jun 2012 #73
Comrade_McKenzie Jun 2012 #37
RockaFowler Jun 2012 #38
BlueCheese Jun 2012 #57
Laelth Jun 2012 #40
soc7 Jun 2012 #64
Hoyt Jun 2012 #69
Zalatix Jun 2012 #104
Hoyt Jun 2012 #108
Zalatix Jun 2012 #109
Hoyt Jun 2012 #110
Warren Stupidity Jun 2012 #80
Ruby the Liberal Jun 2012 #97
4th law of robotics Jun 2012 #105
Iggy Jun 2012 #65
Zen Democrat Jun 2012 #78
prole_for_peace Jun 2012 #81
Daninmo Jun 2012 #113
meaculpa2011 Jun 2012 #114

Response to stopbush (Original post)

Thu Jun 28, 2012, 01:32 PM

1. You go in for treatment and don't get any.

(Except in the ER, if you are hit by a truck.)

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Response to elleng (Reply #1)

Fri Jun 29, 2012, 11:40 AM

10. If it's cheaper to pay the tax

and you can enroll immediately upon finding out you have a serious illness, what's the motiviation to enroll until then?

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Response to B2G (Reply #10)

Fri Jun 29, 2012, 01:24 PM

39. I don't know for sure, but you probably wouldn't be able to enroll "immediately".

For instance, when someone is eligible for Medicare, there is only a short window of opportunity to enroll. IIRC it's about a month at the end of the year. If you don't sign up during that window, you'd be out of luck for another year.

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Response to Tracer (Reply #39)

Fri Jun 29, 2012, 03:12 PM

60. You're talking about Part D...the prescription drug coverage..Medicare is automatic.

You don't have to enroll. It comes with turning 65.

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Response to shraby (Reply #60)

Fri Jun 29, 2012, 03:44 PM

62. My mistake. I must have been thinking of supplemental insurance.

Which DOES have a small window of enrollment.

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Response to shraby (Reply #60)

Sun Jul 1, 2012, 01:25 AM

117. Only Part A

Part B (which covers doctors and outpatient medicine) requires enrollment.

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Response to B2G (Reply #10)

Fri Jun 29, 2012, 01:28 PM

42. Going to be hard to enroll if you go into a coma some day

Sometimes by the time you find out you have a serious illness it is too late.

I would prefer to go with the preventive care I can get with my insurance than to wait until I am dying.

Don

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Response to NNN0LHI (Reply #42)

Sat Jun 30, 2012, 12:36 PM

102. Problem is

your insurance won't pay for many life saving preventative care tests and procedures...they are reserved for the wealthy who can afford to pay out of pocket. Without symptoms no test, when you have symptoms it's too late.

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Response to pipoman (Reply #102)

Sat Jun 30, 2012, 03:25 PM

112. My insurance covers what was negotiated in our union contract

Nothing less. Nothing more.

If I have a problem with my insurance not paying paying for what I think it should or shouldn't pay for I need to take that up up with my union next time we negotiate a new contract.

Don

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Response to NNN0LHI (Reply #112)

Sun Jul 1, 2012, 12:41 AM

116. Presidents, Congress, and the 1%

go in for annual screenings which take days. They get annual full body cat scans and semi-annual PET scans, expensive blood tests, etc. A PET scan can reveal very small malignancies which are producing no symptoms...other expensive tests reveal early onset of disease. How often do we hear about this 1%er or that, diagnosed with cancer...but it is a very small tumor and will have a 100% cure/recovery? Insurance companies OTOH require a diagnosis or suspected diagnosis based on symptoms or routine test results. Once symptoms arise, it can be too late...pancreatic cancer for instance, (my sister is dying of this) the usual first symptom is diarrhea, once one has this symptom the cancer is far more advanced and it is almost always fatal.

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Response to B2G (Reply #10)

Fri Jun 29, 2012, 05:36 PM

77. Preexisting conditions aren't YET covered for all people.

Currently, only kids. The rest of it goes into effect over the next 18 months. So right now you might not be able to just enroll.

Even then, I suspect that there will be a certain amount of delay between enrolling and actual coverage, which is not so good if you have an emergency condition.

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Response to B2G (Reply #10)

Sat Jun 30, 2012, 11:45 AM

89. There are enrollment windows in the bill.

The first is October 2013 - Feb 2014 and after that, it will be Oct to mid-Dec every year.

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Response to stopbush (Original post)

Thu Jun 28, 2012, 01:36 PM

2. You can still go out and get insurance because you can't be excluded....

Why would you get a coverage offset for something you didn't have?? Taxes are paid at the end of the year so you would be paying it for not having coverage during the previous year. When you get sick, you can just go out and get health insurance and as soon as it becomes effective you can get treatments covered.

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Response to stopbush (Original post)

Thu Jun 28, 2012, 01:40 PM

3. Good question.

Medicare costs me $100.00/mo.
Medigap $170.00/mo.
Part "D" $30.00/mo.

That's $300.00/mo. How much is the penalty? Should I drop Medicare?

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Response to Downwinder (Reply #3)

Thu Jun 28, 2012, 01:44 PM

4. $695 a year or 2.5% of your income, whichever is higher...

Everybody should know this by now with all the "coverage" LOL

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Response to snooper2 (Reply #4)

Fri Jun 29, 2012, 11:53 AM

14. So that's about 60 bucks a month

 

seems it would be cheaper to pay the fine and just get insurance when you need it.

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Response to 4th law of robotics (Reply #14)

Fri Jun 29, 2012, 11:56 AM

15. I don't understand this "get insurance when you need it" concept

So say you are building a shed or new roof framing and run a 3" nail through the center of your hand with your pneumatic nail gun. You just going to wrap it in a towel while you shop online for health insurance?

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Response to snooper2 (Reply #15)

Fri Jun 29, 2012, 11:59 AM

17. No, for traumatic injuries that wouldn't be a good idea

 

but let's say you have been relatively healthy so you just pay the 60 per month.

Then you go in and get diagnosed with let's say cancer. Or something that will require expensive long term care (it won't kill you today).

Then you just go and set up an insurance plan before getting treatment.


Consider car insurance instead: if you could just pay 5 bucks a month in fines for not having it wouldn't you? Probably. Especially if you could also purchase full auto coverage at any point regardless of the condition of your car by law. So you roll along for years paying only the fine. Then you get in a bad wreck so you call up the insurers get coverage to cover the repairs and then drop it once that's done.

That would make more sense than paying for it all along.

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Response to 4th law of robotics (Reply #17)

Fri Jun 29, 2012, 12:30 PM

27. If too many circumvent ACA intent, they'll raise the penalty/tax. I think I'd support that.

Especially when there is a public option.

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Response to Hoyt (Reply #27)

Sat Jun 30, 2012, 11:47 AM

90. As it stands now it is set up to fail.

 

It's not different than saying: you must pay your taxes in full. If you don't you will be fined 100 bucks or up to .1% of your income.

Who would pay their taxes in that scenario?

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Response to 4th law of robotics (Reply #90)

Sat Jun 30, 2012, 12:09 PM

98. Certainly those thinking only of themselves won't. Sounds Tbagish to me.

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Response to Hoyt (Reply #98)

Sat Jun 30, 2012, 12:19 PM

100. Certainly. But if people acted sensibly and in the best interest of everyone we wouldn't need

 

a government at all.

A law that rests on the assumption that people won't try to game the system and will set aside their personal interests for the good of the group is a law that is doomed to fail.

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Response to 4th law of robotics (Reply #100)

Sat Jun 30, 2012, 12:41 PM

103. They'll just have to increase penalty because of greedy people.

If anyone wonders why corporations are so greedy, you only have to look at people who only think of themselves who work for them and invest in them.

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Response to 4th law of robotics (Reply #17)

Fri Jun 29, 2012, 01:33 PM

45. that's pretty slimy, actually. I'm sure that they have a way to stop people from being cheaters. n/t

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Response to progressivebydesign (Reply #45)

Fri Jun 29, 2012, 01:59 PM

52. That's the whole point of the mandate.

But if the penalty isn't high enough, it won't have any effect.

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Response to progressivebydesign (Reply #45)

Sat Jun 30, 2012, 11:43 AM

86. Well I suppose people would never do anything that's "pretty slimy" just for money

 

. . .

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Response to 4th law of robotics (Reply #17)

Fri Jun 29, 2012, 01:45 PM

50. My state is way ahead of that thinking and suspends your license

if they determine that you had no car insurance for any length of time. ANY length of time. YOU are the one who has to pay to get all that licensing reinstated. You can't 'outclever' all the state governments all of the time. You certainly don't sound as if you're interested in the efficiencies of large risk and insurance pools.

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Response to ancianita (Reply #50)

Sat Jun 30, 2012, 11:44 AM

87. How would that work in this scenario?

 

Suspend someone's license for not having insurance and they can't drive.

Ok, so what do you suspend for someone who doesn't get health insurance? Their health?

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Response to 4th law of robotics (Reply #17)

Fri Jun 29, 2012, 02:03 PM

56. This is what scares me.

So many here claiming they're "healthy" or "relatively healthy" and don't need insurance.

I didn't know I had cancer. It was caught in a checkup. I felt fine. Great, as a matter of fact. I was 22 years old.
I didn't know I was going to have a heart attack. I felt great. I was 34 years old.
I didn't know I was going to have a stroke...
I didn't know I was going to have two miscarriages...
I didn't know I was going to get into a car accident...

All of those things happened while I had insurance. I haven't had insurance for almost 12 years. I'm a little nervous about going to a doctor, now. But, once I'm able to get insurance...I will.

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Response to Wait Wut (Reply #56)

Fri Jun 29, 2012, 03:53 PM

63. and somewhere in the universe

 

someone got struck by lightning and s/he is kicking himself for not having lightning insurance. Anything could happen to anyone, what you have to consider is the probability of said event happening before going out and buying insurance coverage for it

Sorry about your cancer

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Response to Dokkie (Reply #63)

Fri Jun 29, 2012, 05:25 PM

75. You seriously think that getting sick is...

...as rare as getting struck by lightning? Not one of those things were planned. Any one of them could have been devastating had I not had insurance. This doesn't even include the "little" things that when caught early on can be prevented from becoming "big" things later. If you like to gamble, go for it. I don't, but have been forced to.

Thanks, and good luck.

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Response to 4th law of robotics (Reply #17)

Fri Jun 29, 2012, 05:38 PM

79. Yes you can game the system like that.

That is why the tax is there to begin with. Presumably if enough people do this the tax will go up.

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Response to Warren Stupidity (Reply #79)

Sat Jun 30, 2012, 11:45 AM

88. Perhaps, but as it stands it's set up to reward gaming the system

 

the tax should be at least as high as the median cost for health insurance to be effecitve.

60 bucks is far too low to convince people who are forgoing health insurance now to save money (a gamble) to make the switch.

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Response to snooper2 (Reply #15)

Fri Jun 29, 2012, 01:29 PM

43. I don't get it either. That is whole idea of insurance, you get insurance to

cover an unexpected expense be it a fire, flood, storm, theft, wreck etc. How can anyone expect to get health care insurance after you get sick? If you can't get Medicare for all what else can be done. Isure as hell don't want to continue paying higher insurance premiums to pay for someone elses healthcare while they take free ride.

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Response to Downwinder (Reply #3)

Fri Jun 29, 2012, 07:49 PM

83. And I am asking a question here.

I'm not advocating any strategy or position. I'm asking: what happens if you don't buy insurance, pay the tax penalty and then get sick?

I haven't heard anybody addressing this scenario in the media.

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Response to stopbush (Reply #83)

Sat Jun 30, 2012, 12:22 PM

101. I'n not certain, but.....

I would imagine that coverage does not start immediately....there most likely is a waiting period. So, that might be OK unless you get a serious illness or have an accident before the insurance kicks in. Then, you're left with all the medical bills from treatment and the premium payments for the insurance when it does kicks in. Insurance is costly, yes. But not being insured can be far more costly if you're in need of some serious treatment. I would never take the chance of racking up medical bills without decent health insurance coverage. Scenario: You have a serious accident that keeps you out of work. All your sick and vacation days are used up. It might be difficult to pay insurance premiums and living expenses until you're back to work, but it would be far more difficult if you had a mountain of medical bills because you don't have insurance. Just things I think about.

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Response to stopbush (Original post)

Thu Jun 28, 2012, 01:49 PM

5. You pay out of pocket or don't get care........or you buy insurance, which can no longer deny you

due to pre-existing conditions. That tax/penalty is an incentive to just go ahead and get insurance before you get sick. Saves people from their own shortsightedness in theory.

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Response to kestrel91316 (Reply #5)

Fri Jun 29, 2012, 11:56 AM

16. But if the tax works out to 60 bucks per month

 

and insurance companies must give you coverage regardless of your health wouldn't it then make economic sense to pay the tax until such time as you actually need expensive care?

Not many health plans are under $60/month.

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Response to 4th law of robotics (Reply #16)

Fri Jun 29, 2012, 12:31 PM

28. I'm sure it will make sense to Republicans who are always trying to screw society.

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Response to Hoyt (Reply #28)

Fri Jun 29, 2012, 01:44 PM

49. .....and the poor and downtrodden especially.

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Response to kestrel91316 (Reply #49)

Fri Jun 29, 2012, 01:59 PM

53. Fortunately, poor will have subsidies or totally free coverage like Medicaid (with not copays, etc.)

If that is not the case, then things are different. But, I believe it is the case.

Further, the care will improve people's lives. That's why it bothers me that people who presumably can pay something are already looking to game the system. No need to be like greedy rethugs at society's expense.

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Response to Hoyt (Reply #28)

Sat Jun 30, 2012, 11:55 AM

93. Or anyone who can do math

 

if you incentivize gaming the system you really can't be surprised when people game the system.

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Response to 4th law of robotics (Reply #93)

Sat Jun 30, 2012, 12:11 PM

99. Especially if they don't give a rip about society, only their greedy selves.

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Response to Hoyt (Reply #99)

Sat Jun 30, 2012, 01:12 PM

107. You overestimate people

I don't see how this is much better than today. A significant number of unisured are currently eligible for Medicaid or can affort healthcare...yet they never enrolled.

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Response to 4th law of robotics (Reply #16)

Fri Jun 29, 2012, 01:42 PM

48. Some people might do that. It's a flaw in the system if that's the case.

I believe ACA is extremely flawed and will eventually need to be modified so much that we wind up with single payer. But in the meantime, it's way better than what we have had in the past.

Several years ago I had good medical insurance - a group policy. It cost $500/mo and had a $7500 or $10,000 deductible, I forget which. Plus 80/20 copay and I forget how high the annual out-of-pocket maximum was. Basically, between premiums and deductible and copays I would have had to spend over $15,000 of my own money before they covered A SINGLE PENNY OF CARE.

I had to give it up. There was no point, because as a healthy person all I ever did was see the Dr for preventives and minor stuff. I thought at the time that there ought to be a law against such thievery. And now there is.

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Response to kestrel91316 (Reply #48)

Fri Jun 29, 2012, 02:02 PM

55. How does the ACA stop plans like yours?

It might lower the upfront out-of-pocket costs a little, but it will still be many thousands of dollars before insurance kicks in.

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Response to BlueCheese (Reply #55)

Fri Jun 29, 2012, 03:12 PM

59. Wrong. You need to read up on it on the healthcare.gov website.

They are capping deductibles at something like $2500, IIRC. And preventive care is covered 100% with no deductibles or copays. That means pap smears, mammograms, colonoscopies with zero put of pocket for everybody eventually. As of Aug 1 2012 (1 mo from now) new policies must provide preventive care free.

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Response to kestrel91316 (Reply #59)

Fri Jun 29, 2012, 04:14 PM

67. According to this analysis from the KFF...

For a bronze plan, the max out of pocket for a year will be $6,350. Insurers can structure things as they wish--larger deductible, smaller coinsurance, or vice versa. As that analysis shows, that could entirely be in the form of deductible.

http://www.kff.org/healthreform/upload/8177.pdf

I agree with you about preventive care.

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Response to kestrel91316 (Reply #48)

Fri Jun 29, 2012, 04:08 PM

66. That is NOT "good medical insurance." n/t

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Response to kestrel91316 (Reply #48)

Sat Jun 30, 2012, 11:58 AM

94. Actually it sounds like it made things worse

 

consider: if any significant number of people realize that 60 bucks is far less than the 100+ they are paying per month and drop their coverage revenues for insurance companies will drop. This will force them to raise costs on the people who are left especially once those people who made the sensible, albeit selfish, decision to drop their coverage renew once they are actually sick.

So you'll have fewer people paying in but more people taking out.

That won't work. Even if the insurance companies are run as non-profits that system is guaranteed to fail. The whole point of insurance is that you have a lot of people paying in who probably won't use it (or not as much as they are paying) to cover those who will use it. This creates an incentive to not pay in until you need it.

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Response to 4th law of robotics (Reply #16)

Sat Jun 30, 2012, 02:30 PM

111. you'd be ok with paying $60/mo for nothing? seems financially stupid to me.

young people can get less expensive insurance now than older ones. in order for aca to work, i imagine the gummint will try to help as much as possible.

ellen fl

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Response to ellenfl (Reply #111)

Sat Jun 30, 2012, 07:46 PM

115. It's not for nothing

 

it's for the privilege of not paying more.

I'd gladly pay 60 bucks for "nothing" if it got me out of paying 300 bucks for "something" that I could also get by going the cheaper route.

Do the math: 60 per month x 12 months = 720.

Let's say 200 per month for health insurance x 12 months =2400.

Ah but what if you get sick halfway thru the year? Ok so that's 60 x 6 + 200 x 6 = 1560 or about 900 dollars in savings.

Not an inconsequential amount to many people.

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Response to stopbush (Original post)

Thu Jun 28, 2012, 02:22 PM

6. I don't understand how this affects folks like me...

Unemployed 5 years, no savings left, no job on the horizon.

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Response to sunwyn (Reply #6)

Thu Jun 28, 2012, 03:12 PM

7. Go to www.healthcare.gov and find out.

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Response to sunwyn (Reply #6)

Fri Jun 29, 2012, 01:05 PM

32. It doesn't affect you if your income is below 133% of the poverty level.

Medicaid eligible people aren't subject to the penalty, but I suspect you knew that.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 11:30 AM

8. Usage of penalty tax

I've read that the penalty tax can't exceed the premium of an insurance plan at the Bronze level. So it's somewhat tied to insurance coverage costs.

But where does that money go? I can't find a specific answer. Does it go into the general Treasury? Or is it designated for a fund that will go to supporting the costs of penalty payers who get sick and buy insurance?

I'd be interested in seeing actuarial predictions of who will go with the penalty with projections of the costs of covering their illnesses.

If the uninsured tax does go into a special health care fund rather than the general Treasury, then it's kind of a public option.

And incremental reform of the ACA would, of course, be: if you don't buy insurance, you pay the tax and that money is used to automatically enroll you in an insurance plan. (Could be a private plan or, better a public option.) Doesn't Massachusetts do automatic enrollment?

Of course, the politics of this happening soon are nil, but we have planted the flag.

When Social Security was enacted, it had to survive court challenges, and it was a much more bare bones program than today.

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Response to Latichever (Reply #8)

Fri Jun 29, 2012, 11:38 AM

9. It doesn't go into a special fund

The penalty is not an alternative coverage plan. It is a straight penalty (or tax, whatever) designed to incentivize participation in a plan. To the extent that funds go into general treasury, they are available in principle for the various health programs, but no more (and no less) available than any other funds in the general.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 11:41 AM

11. If you don't have insurance and you "come down with cancer," you go and get insurance, or pay out of

pocket. You can't be denied insurance for a preexisting condition.

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Response to alcibiades_mystery (Reply #11)

Fri Jun 29, 2012, 11:52 AM

13. I still don't understand the incentive

for people to buy the insurance.

If I have a family of 4 and our total income is $75,000, our premiums would be around $7000 per year, taking the subsidy into account.

If they choose to forego insurance, the tax would be around $1800.

If something catastrophic occurs, they can immediately enroll and get coverage.

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Response to B2G (Reply #13)

Fri Jun 29, 2012, 12:09 PM

19. Accidents.

Let's say you fall in the yard and need emergency leg surgery. You cannot retroactively be covered.

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Response to RagAss (Reply #19)

Fri Jun 29, 2012, 12:14 PM

21. And if the injured can't conver the uninsured expenses

who pays for that? How is that any different than it is today?

In the meantime, the unisured has only paid a small tax and saved thousands by foregoing coverage.

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Response to B2G (Reply #21)

Fri Jun 29, 2012, 04:32 PM

68. The rest of us pay for it. And that's OK by me for people who have it tough. Not so much with

people taking advantage of the system.

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Response to B2G (Reply #21)

Sat Jun 30, 2012, 11:59 AM

96. Your risk is medical bankruptcy.

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Response to B2G (Reply #13)

Fri Jun 29, 2012, 12:15 PM

22. You're absolutely right.

Especially when you consider that the low-end plans will likely come with large deductibles, it really makes little sense to get insurance. Even if you have insurance, you'd still have to pay a fair bit out of pocket before you get any benefits. It makes a lot more sense to simply pay out-of-pocket, and then sign up if something terrible happens.

What this means, of course, is that for the whole thing to work, the penalty and the cost of the insurance would have to be close--around the value of insurance to a healthy person, which I gather would be the value of things like preventive care, which aren't subject to the deductible. If not, the rational outcome would be ever-higher premiums as only the sickest patients find it worthwhile to get insurance.

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Response to BlueCheese (Reply #22)

Fri Jun 29, 2012, 12:22 PM

25. Yes. I think of ACA as "Disease" insurance.

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Response to B2G (Reply #13)

Fri Jun 29, 2012, 01:08 PM

33. $7000 a month... what the fuck.

 

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Response to Zalatix (Reply #33)

Fri Jun 29, 2012, 01:13 PM

34. That's an annual amount

and accounts for a $4K government subsidy, so the actual cost is around $11K.

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Response to B2G (Reply #34)

Fri Jun 29, 2012, 01:37 PM

46. Ah, misread. Mybad.

 

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Response to B2G (Reply #13)

Fri Jun 29, 2012, 02:27 PM

58. It isnt much of an incentive. I think they had to try to get it passed as a first step.

Making it a real incentive may come in the future.

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Response to B2G (Reply #13)

Sat Jun 30, 2012, 11:58 AM

95. You can't 'immediately enroll'

You have to enroll during the enrollment windows, 4 months in 2013-14 and 8 weeks a year after that.

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Response to alcibiades_mystery (Reply #11)

Fri Jun 29, 2012, 01:47 PM

51. You can be denied for pre-existing until Jan 2014.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 11:42 AM

12. That's going to be the most rational way to go, for many people. Probably there will be seminars

and books explaining how to best game the system.

Suppose you come down with cancer. Do you go out and buy insurance at the point you're diagnosed,


You can buy insurance when you are diagnosed. I believe there may be a waiting period of 6 months...

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Response to stopbush (Original post)

Fri Jun 29, 2012, 12:08 PM

18. You bring up an excellent point.

At that point, after finding out you have cancer, you'd sign up for insurance, which can no longer be denied you.

This means, of course, that for the mandate to work, the penalty tax has to be high enough that even a healthy person would decide to get insurance instead. Otherwise, everyone would pay the penalty until something catastrophic happens, meaning that those with insurance would be very high-risk, meaning that premiums would necessarily be very high. My own guess is that until the penalty is more or less comparable to the actual cost of insurance, it won't have an effect.

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Response to BlueCheese (Reply #18)

Fri Jun 29, 2012, 12:10 PM

20. The problem is, it's not

See my example upthread.

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Response to B2G (Reply #20)

Fri Jun 29, 2012, 12:16 PM

23. Just responded to you as you were responding to me.

I agree with you.

A low penalty is about as bad as having no penalty at all. Unless the penalty is painful, it won't work.

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Response to BlueCheese (Reply #23)

Fri Jun 29, 2012, 12:17 PM

24. Absolutely n/t

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Response to BlueCheese (Reply #23)

Fri Jun 29, 2012, 12:35 PM

29. So, they will raise it as soon as they see a lot of people trying to screw the rest of us.

If people do try to game the system at others expense, I'd support raising the penalty/tax. This assumes people who can't afford health insurance have subsidies or other viable options.

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Response to Hoyt (Reply #29)

Fri Jun 29, 2012, 01:17 PM

36. Or they will slide it upward on the grease of the for profit "health" insurance industry's bribes,

lobby money, campaign cash and issue advocacy propaganda whether it needs to be raised or not.

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Response to Uncle Joe (Reply #36)

Fri Jun 29, 2012, 01:38 PM

47. Whatever, it's kind of disturbing seeing people already trying to game the system.


We don't have to be like the friggin greedy corporations.

In any event, this is a good step forward on what will be a long fight against all of those trying to screw society -- insurers (who will eventually be squeezed out except maybe to continue administering things like they do now with Medicare and even Medicaid); rethugs; providers; and even beneficiaries/patients who'll try to take advantage of system at expense of others.

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Response to Hoyt (Reply #47)

Fri Jun 29, 2012, 02:01 PM

54. I think the most gaming of the system will be from people like me. I will retire early

when I can get the medicaid for free at 133% of poverty level. I am now 41 so I will retire in two years at 43. My house/farm is paid for already and my non-tax deferred accounts generate about $17k per year in dividends/interest so my wife and I would just barely qualify. No debt at all, grow most of our own food, well, solar panels so our cost of living is about 12k per year. We had been talking about retiring early but the cost of health care was always the big stumbling block.

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Response to Hoyt (Reply #47)

Fri Jun 29, 2012, 03:28 PM

61. I have always believed the people or entities most able to game any system and get away with it

are those with the most money.

"They're too big to fail," or "national security" or a multitude of other reasons, it's that old spin on the Golden Rule, "He/she who has the most gold rules."

In this case the private for profit "health" insurance corporations have the most gold, and now they have been institutionalized as being the middlemen in regards to health care, via mild coercion for now, but the screws will undoubtedly tighten if their gold has any influence, and I'm not just speaking of higher fines for not having insurance but in all aspects of the ACA.

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Response to Hoyt (Reply #47)

Fri Jun 29, 2012, 04:47 PM

70. "We don't have to be like the friggin greedy corporations."

Why not?

Those greedy corporations just forced a $60 billion tax down the throats of the middle class and working poor to raise their profits and line shareholder pockets.

People should game the system as hard as they possibly can. Fuck being good little moral peasant pawns while the corporations loot and pillage our wealth, our resources and our labor. If you want to be a 1% fluffer, that's your choice.

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Response to girl gone mad (Reply #70)

Fri Jun 29, 2012, 05:03 PM

71. Problem is, it's not at corporate expense. Those who pay the premiums will have to pay for those who

will purchase insurance the moment they need it. Obviously you don't understand that the corporations will get their 15 - 20% admin/profit percentage and the rest of us will pay your way. Or maybe you do.

Again, if you need us to pay your way, I'm fine with that. If you are just being greedy like corporations, not so much.

I suppose some will do the same thing when there is a public option.

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Response to Hoyt (Reply #71)

Fri Jun 29, 2012, 05:15 PM

74. Maybe you should have fought this bill, then.

Before ACA, the government picked up the tab for most uncompensated care.

Considering that we have a sovereign currency, it wasn't such a bad deal.

As you say, now some those costs will be shifted on to policyholders and people who can't even afford to purchase policies.

And what of the costs of the insured who will continue to have claims denied? This has always accounted for a sizable portion of uncompensated care and denials are actually projected to skyrocket once the ACA is fully implemented. Medical bankruptcies will persist.

I'm assuming you support this bill. Did you not understand what was in it? If you didn't want to pay for people "gaming the system" you should have lobbied for single payer.

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Response to girl gone mad (Reply #74)

Fri Jun 29, 2012, 05:27 PM

76. I'm fine with people who need subsidies. I'm not fine with people who don't screwing the rest of us

You'll have a lot fewer claims denied under ACA -- there are now rules to stay on the exchanges and receive federal qualification.

Do you have a citation that denials will skyrocket? There will be less medical bankruptcies. For one reason, someone who loses their job because of cancer can now get coverage without worrying about pre-existing conditions. If they have little money, they'll get subsidies.

This law was better than nothing and is a step toward the ultimate. But, if you can pay premiums and choose to play the system, you'll be screwing the rest of us. That seems to be OK for some.

I was for single payer -- but, believe it or not, you and I would have to pay into that system too. It won't be free. And, it won't be cheap because a fundamental change of our health care system will take decades. The providers will have to change, and patient expectations will too. But, I suppose it will still be OK for some to game a single payer system too. Not only do we have to worry about the right wing greedy, but . . . . . . .

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Response to girl gone mad (Reply #74)

Sat Jun 30, 2012, 01:09 PM

106. First off I wanted Single Payer

Either tricare or Medicare would have worked, but I also live in the real world where EVIDENCE, has shown that in Massachusetts, the model for this... all the horrors you spoke off, have not materialized. Oh there were predictions too.

Worst, costs of medical delivery in the State have actually gone down.

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Response to B2G (Reply #20)

Fri Jun 29, 2012, 12:29 PM

26. The current penalty is just the nose of the camel under the tent, it will be increased.

No doubt, the for profit "health" insurance industry are already hard at work bribing and lobbying Congress to weaken or eliminate any and all provisions detrimental to them and beneficial to the consumer.

The penalty will be raised but that will just be the beginning of the for profit "health" insurance industry's efforts, they will also be heavily funding the campaigns of industry sympathetic politicians to power not to mention plenty of issue advocacy propaganda beneficial to their cause.

The mandate will most certainly help the for profit "health" insurance industry in their political endeavors.

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Response to BlueCheese (Reply #18)

Fri Jun 29, 2012, 05:12 PM

72. It should like the insurance cost

The same amount. That way they are "forced" to be insured. That's been the whole complaint about being "forced to buy insurance." Which in essence single payer would do. So that's the way of forcing them into the system for their own good, because they are stubborn and dumb. In a way it makes little difference in the end whether it is single payer or this, just a structural difference.

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Response to treestar (Reply #72)

Fri Jun 29, 2012, 08:54 PM

84. Single payer would probably be financed through general taxes...

So it would be funded in a much more progressive fashion. It would also take insurance company profits out of the mix.

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Response to BlueCheese (Reply #18)

Fri Jun 29, 2012, 06:07 PM

82. The SC ruled that the reason the mandate is ok

is because the tax isn't big enough to actually force you to buy insurance. They basically said there is no mandate because the tax is so small. If the tax was increased enough to actually force people to buy insurance it would probably go back to the supreme court and be found unconstitutional.

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Response to DesMoinesDem (Reply #82)

Fri Jun 29, 2012, 08:56 PM

85. Really? That's interesting.

Because it seems we have a Catch-22 in that case. Too small a penalty and it won't work. Too large and it's unconstitutional. Though maybe the Court will look different by then.

Do you have a link to some legal analysis? Thanks.

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Response to BlueCheese (Reply #18)

Sat Jun 30, 2012, 11:50 AM

91. A smarter way to do it

 

would have been to simply automatically enroll everyone in medicare. Tax them for that based on their income (below poverty level nothing, progressive rates after that).

To not be on medicare (and be exempt from the tax) you would have to show that you have some other insurance.

That way everyone is covered. Everyone is paying in. You can make the tax heavy enough that people who can afford other insurance would want to get it from another source. As medicare wouldn't deny anyone coverage those with preexisting conditions would be covered.

There. Free-rider problem solved. And it allows some flexibility for competition between private/public insurers.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 12:38 PM

30. What happens if you simply don't pay the tax? Would your paycheck be garnished? Would they put you

in jail?

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Response to patricia92243 (Reply #30)

Fri Jun 29, 2012, 12:43 PM

31. My understanding is that the same consequences apply

as not paying your federal income taxes. You would be subject to garnishment, property seizure and any other nightmares the IRS chooses to inflict upon you.

They are also adding a buttload of IRS agents for enforcement.

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Response to B2G (Reply #31)

Fri Jun 29, 2012, 01:16 PM

35. No true.

"Enforcement: The penalty will be paid as a federal tax liability on income tax returns and is enforced by the Treasury. Individuals that fail to pay the penalty will not be subject to criminal penalties, liens or levies."

https://www.bcbsri.com/BCBSRIWeb/pdf/Individual_Mandate_Fact_Sheet.pdf

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Response to Avalux (Reply #35)

Fri Jun 29, 2012, 01:27 PM

41. But it is now an official tax

it's no longer a toothless penalty. I'm assuming that this amount will be deducted from any refunds that are processed.

If no refund is forthcoming, and levies, leins and penalties don't apply, why on earth would anyone pay it?

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Response to B2G (Reply #41)

Fri Jun 29, 2012, 01:30 PM

44. The law has not changed since it was signed. It was upheld by the SC.

What's in the law, as I posted, remains unchanged (at least for now).

If this is truly the case, then no one will pay it, and people will stop buying insurance. Corp insurance companies could take a big hit depending on how this all plays out.

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Response to Avalux (Reply #35)

Sat Jun 30, 2012, 11:54 AM

92. So you won't even be penalized for not paying this paltry tax?

 

What's the point then?

Here's the deal: pay your taxes in full and on time. If you don't you will be fined .1% of your income. And if you don't care to pay that penalty we will not pursue it or punish you in any way.

Next year: why are we broke?!?!?

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Response to patricia92243 (Reply #30)

Fri Jun 29, 2012, 05:12 PM

73. Anyone getting a refund might have it taken out

That's the IRS first course of collection.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 01:20 PM

37. What about a single-income husband and wife?

 

My dad gets the cheapest thing he can afford, but it's an extra $400 a month to add mom.

He simply cannot afford to do that. He barely has an extra $10 at the end of the month after bills.

Would he be penalized for not adding her?

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Response to stopbush (Original post)

Fri Jun 29, 2012, 01:21 PM

38. Who knows when they will get sick??

I got into an argument yesterday with someone who has no Health Insurance for herself and her husband. Look I just got out of the hospital. I had a gallbladder attack. If I didn't have insurance I would be stuck with a $100,000 bill right now. Instead I have to pay my deductible - $2000. Isn't $2000 a lot better than $100,000??

Oh and this same person belives God will take care of all. And this woman has 3 kids. Who will take care of her 3 kids if, God Forbid, anything happens to herself and her husband?? What about the ongoing medical expenses??

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Response to RockaFowler (Reply #38)

Fri Jun 29, 2012, 02:10 PM

57. Under the ACA...

... you could have signed up for insurance in between diagnosis before getting treatment. I suppose it was a serious emergency--i.e. you had to have it done immediately (within minutes), then you'd have been out of luck. In that case I wonder if you would have been treated at all?

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Response to stopbush (Original post)

Fri Jun 29, 2012, 01:26 PM

40. You buy insurance as soon as you suspect you are seriously ill.

Or, it appears to me, that would be the rational economic decision.

No insurance means you're on your own for the bill, but there's scant reason to buy insurance unless you are, in fact, ill. Paying the tax penalty will not count as having purchased insurance.

-Laelth

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Response to stopbush (Original post)

Fri Jun 29, 2012, 03:58 PM

64. You better believe I'm going with the penalty route....

 

That's too big of a savings to ignore...

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Response to soc7 (Reply #64)

Fri Jun 29, 2012, 04:36 PM

69. Let me say thanks to you for pocketing the savings at society's expense.

Now if you are in a tough situation, that's one thing. Another if you act like a corporation and take the route that leaves more money in your pocket (bank vault) at everyone else's expense.

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Response to Hoyt (Reply #69)

Sat Jun 30, 2012, 12:41 PM

104. But you're not seeing the scope of the problem here.

 

Millions might decide to do the same thing.

Do you realize that Southwest Airlines is thinking about dropping its health care coverage for its employees, using the same logic?

Paying for health care under the ACA: $411 million for Southwest.
Not paying for health care and paying the tax penalty instead: $111 million.

You may now pick your jaw up off the floor.

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Response to Zalatix (Reply #104)

Sat Jun 30, 2012, 01:37 PM

108. Apparently SW Airlines is run by same greedy people who would game system on the individual side.

First off, I doubt SW will ultimately drop it because to employees each dollar of health insurance is more valuable to employees than $1 in wages.

And, if SW had dropped health coverage before there was a penalty they would have saved $400 Million, rather than $300 million. But, they didn't. Why do you think they will now?

In any event, if SW and other employers drop it -- single payer or public option is all but assured. In the meantime, those of us who feel responsible for insuring our families in case of major illness have a way to do it.

You have also ignored the incentives for small businesses -- who haven't offered health insurance before -- to do so. Of course, if the same greedy people who are not looking for ways to game the system, run those small businesses, employees won't get chit.

In any event, we are going to have to pay for it -- either as a direct increase in taxes or through premiums. Health care will not be free. I wish it could be, but it's not.

And, most of us would rather have health insurance for our families. The responsible folks will have to pick up bill for irresponsible gamers. I'm fine with that. As long as the poor are protected with subsidies, I think it is time to go ahead with this and make it work (including improvements) and to quit griping about the things the aren't perfect, but better than what we had under the status quo.

Just one ole fucker's opinion.

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Response to Hoyt (Reply #108)

Sat Jun 30, 2012, 01:48 PM

109. I'd rather pay for it in taxes, to the Medicare for All program. Here's why.

 

Okay, here we go.

The law of large numbers is an insurance term that says the larger the number of insureds on your policy, the less risk of loss you as an insurer suffer from people getting sick. IOW an insurer is more stable when they have 100,000 policyholders paying premiums than 1,000: the number of sick people is less likely to exhaust your funds.

Inductively, this means Medicare for All, by definition a policy that covers all Americans, is a risk pool of 300+ million Americans. No insurance company can ever come anywhere close to this risk pool.

Furthermore, insurance corporations have about 20-30% operational overhead, that means for every 1 dollar you pay them in premiums, only 70-80% goes to providing you insurance coverage. Medicare? 3%, which means 97% of the taxes you pay into it, goes into providing you insurance coverage.

On top of this, Medicare is accountable to voters. What voters can tell Cigna what to do?

Your dollar goes much further with Medicare for All than it ever will with private insurance corporations.

The problem with the individual mandate is it invites people to not be insured and pay a tax penalty instead. This will bite us on the ass. These cheaters will make us worse off than before the mandate came along.

Medicare for All? Everyone is covered, automatically.


BTW: I never once said I oppose all of the ACA, or that I want to see it abolished. The problem is the individual mandate.

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Response to Zalatix (Reply #109)

Sat Jun 30, 2012, 02:08 PM

110. Look, they can't have 20-30% overhead anymore. I want Medicare for all, but we didn't get that.

The problem with the individual mandate is that people only think of themselves. That may be human nature, but we will never end up with a wonderful society like Denmark or something when everyone acts like a greedy hog.

Voters can tell GIGNA what to do. In fact, we just did.

They will now have to follow federal guidelines, cut their profits, abandon pre-existing, compete in the Exchanges with non-profit insurers, develop better integrated delivery models, etc.

Now, we can cut CIGNA's profits even further by merely amending a few phrases in the legislation. In fact, we can keep cutting the overhead/profit percentage until the Cignas, Uniteds, Blue Cross, etc., are administering health coverage at Medicare's overhead rate. Those same companies you are gripping about administer Medicare under federal guidelines right now. Is it beginning to sound familiar?

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Response to soc7 (Reply #64)

Fri Jun 29, 2012, 05:45 PM

80. Good luck with that.

By the way you will be on the hook for the expenses you incur prior to getting insured. So for example you could have an uninsured heart attack. That could set you back at least 100k before you manage to get insurance, and I guarantee you the insurance company is not going to pay up for expenses you incurred while uninsured. So you lose your house, or your savings, or both, but hey you sure showed that damn gummint, huh?

Medical bankruptcies are one of if not the leading cause of personal bankruptcies.

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Response to soc7 (Reply #64)

Sat Jun 30, 2012, 12:08 PM

97. Better hope you never get sick then.

But if you do, good luck with the medical bankruptcy.

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Response to Ruby the Liberal (Reply #97)

Sat Jun 30, 2012, 12:56 PM

105. Being sick would be fine

 

no preexisting conditions any more.

The only risk financially in going this route is for sudden traumatic injury.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 03:59 PM

65. You're Dead

 

uhhh, cancer does not show up overnight like poison ivy or a freakin toothache.

you can have colon cancer and not know it, or ignore the symptoms. if it gets to
stage four, moves into your liver, stomach, etc., you'll likely end up dead.

this is the whole point of health CARE... getting regular checkups, finding illnesses like cancer early
when it's not terminal, etc.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 05:37 PM

78. My appendix burst when I was 24.

I certainly didn't have time to shop for insurance, so it was a great thing that I was already covered. I imagine that someone who didn't have it would get whopping bills from the hospital/doctor/anethesiologist for which they would be responsible, and then have a ACA penalty. Better to pay the premium and be covered and not worry.

I had a cousin who was covered for 30 years and then lost her job and went without it for a year. During that year she had an aneurism. She was sent to the county charity hospital for brain surgery. Not an ideal situation.

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Response to stopbush (Original post)

Fri Jun 29, 2012, 05:57 PM

81. But how long will it take for the insurance to go into affect?

You would have to find a insurer and a plan that you want. Then you have to sign up and get enrolled. And then activate the insurance with your premium payment. I don't think it will be instant or even a day or two. It could be weeks before you had coverage.

In a cancer diagnosis wouldn't you want to start on treatments as soon as possible? And what if you have an accident?

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Response to stopbush (Original post)

Sat Jun 30, 2012, 03:35 PM

113. Why

would the ACA tax be any different than any other tax? Many people will take every legal and some illegal exemptions on their state and federal income taxes when they could just pay the full amount. But it is legal to take some exemptions, so they do it.

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Response to stopbush (Original post)

Sat Jun 30, 2012, 03:54 PM

114. Apply for insurance every year...

sign the check, put it all in the envelope and wait. In case of illness, pop it it the mail. That's what people did in NYS back in the 90s when the state prohibited exclusions for pre-existing conditions. Not saying it's right. I paid up ($950 per month for my family back in 1995) but plenty of people went the scam route, which is why the state instituted the enrollment period. For a free-lance writer with a wife and two young kids it was a big chunk out of our income, but worth it for the peace of mind. We actually considered moving out of state where health insurance premiums were less than half, but...

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