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Isn't there a federal non-profit option or some such if the state refuses to run its own exchange? The cliff is a very interesting bit of head-scratching for people who own more than 2% of an LLC and buy themselves insurance through non-group plans [me]. From what I can tell it basically is a situation where there's about a $10,000 range [from about 46-56k or so] where the combination of insurance costs and taxes on the income make it effectively not a good thing to raise your wages in that area. I could be reading everything totally wrong though. e: I suppose this would apply to anyone making wages in that area assuming their employment doesn't provide healthcare. Though that tends to be the realm of salaries where benefits of some level are just sort of standard. oilcheck my ass fucked around with this message at 21:32 on Apr 3, 2013 |
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Apr 3, 2013 21:29
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oilcheck my rear end posted:Isn't there a federal non-profit option or some such if the state refuses to run its own exchange? I'm not quite sure about the rules on business ownership, but for non-owners, there's a HUGE affordability cliff when you pass 400% of the poverty line (and thus are no longer receive subsidies). If you buy your own insurance, making 401% of FPL is way worse than making 399%.
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Apr 3, 2013 21:33
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Amused to Death posted:Takes money to make money folks I don't think this is right; Missouri is certainly not expanding medicaid. Are you sure this map isn't a list of states running their own exchanges?
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Apr 3, 2013 21:48
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Goatman Sacks posted:I don't think this is right; Missouri is certainly not expanding medicaid. Are you sure this map isn't a list of states running their own exchanges? Its problem is it's looking only at governors in favor: Missouri's governor is in favor but is being blocked by the legislature.
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Apr 3, 2013 21:52
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Specifically it's where each state's governor stands on the issue, which usually means where the state itself stands, but Missouri seems to be the odd child out. The map on the site itself though does in fact list whether or not a state is running its own exchanges http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap e: beaten Although, it appears partial Medicaid expansion is not quite dead in MO http://www.stltoday.com/news/local/...4d5a914c97.html However, the feds have said they will not pay higher reimbursement unless states go to the full expansion.
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Apr 3, 2013 22:00
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Are the premiums you pay to an exchange going to be deducted from your wages, or will you have to pay a third party?
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Apr 3, 2013 22:28
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watt par posted:It's the other way around. Lots of hospitals in red states are pissed over their governments refusing the Medicaid expansion because it means hundreds of millions they're missing out on. From what my aunt's been saying, her hospital loses money on the Medicaid patients and will possibly lose money on Medicare ones, as the rates they're allowed to bill doesn't cover their overhead. That's her worry, and I've heard other anecdotes as well. It doesn't make much sense to me that hospitals wouldn't be able to find cost savings somewhere, but they'll probably do so by laying off staff. I think my mom's worry is that in the meantime some hospitals might flat out refuse Medicare patients, as I've read that some refuse Medicaid ones for the same reasons. Basically this, but not due to sequester, just due to Medicare limits: http://www.washingtonpost.com/blogs...-the-sequester/ And speaking of exchanges, I just saw an article stating that exchanges wouldn't have more than one plan on them until 2015 (a year delay). I'm not sure how true this is or its ramifications, though. http://www.nytimes.com/2013/04/02/us/politics/option-for-small-business-health-plan-delayed.html?_r=0 quote:The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan. mastershakeman fucked around with this message at 00:03 on Apr 4, 2013 |
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Apr 3, 2013 23:59
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mastershakeman posted:And speaking of exchanges, I just saw an article stating that exchanges wouldn't have more than one plan on them until 2015 (a year delay). I'm not sure how true this is or its ramifications, though. http://www.nytimes.com/2013/04/02/us/politics/option-for-small-business-health-plan-delayed.html?_r=0 Guess the Republican plan of forcing the government to run the exchanges worked. Maybe now people will realize how terrible Obamacare really is. 
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Apr 4, 2013 03:06
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Sarion posted:Encourages Part-time jobs This is a big problem. I'm not personally affected by this, but I know lots of employees at my workplace who may indeed have their hours cut down to around 28 a week because of this provision, and many of them aren't making enough money as it is and will probably have to try to find a second job. To be honest, I suppose stuff like this was to be expected, at least somewhat, seeing how during health reform, there were two ways you could've went, and sided with either the health insurance companies or business, the latter of which would've probably much preferred single payer, or at least a public option.
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Apr 4, 2013 03:16
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So the ADP report came out this month, with less-than-stellar numbers. In addition to a drop in construction hiring, "Concern over the impact of changes in health- care law may have also curbed hiring at companies with around 50 employees" is said to have contributed to the results.
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Apr 4, 2013 13:15
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I remember reading an effortpost after the scotus decision which alleged that the PPACA would inadvertently lead to a collapse of the health insurance industry and an 08 banking crisis style federal rescue of hospital systems. I realise that its not much to go on (I've looked and can't find the post anywhere) but do you think it has any grounding in reality?
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Apr 4, 2013 23:31
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twoot posted:I remember reading an effortpost after the scotus decision which alleged that the PPACA would inadvertently lead to a collapse of the health insurance industry and an 08 banking crisis style federal rescue of hospital systems. That seems rather unlikely. I don't see any obvious mechanism by which that sort of thing would happen. The health care insurance industry will still be making plenty of money under the new system. The hospitals are a somewhat different matter. Medicare had a provision for reimbursing hospitals for indigent care. The PPACA eliminated that on the assumption that virtually everyone showing up at a hospital would have some sort of insurance in the future. A significant part of that coverage was going to be from the Medicaid expansion. The states that are refusing to go along with that provision are indeed precipitating a crisis in their hospital networks, as that subsidy from Medicare is gone, and yet there are still going to be lots of uninsured people that the hospitals are legally obligated to treat. Hospitals that serve primarily the rural and poor are going to bear the brunt of it. I doubt the Feds are going to do much to help, however, when the solution to their problem already exists.
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Apr 5, 2013 00:05
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The sheer amount of federal dollars Texas will miss out on will eventually drive us into accepting the expansion; it may take a few years though.
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Apr 5, 2013 01:33
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mastershakeman posted:From what my aunt's been saying, her hospital loses money on the Medicaid patients and will possibly lose money on Medicare ones, as the rates they're allowed to bill doesn't cover their overhead. That's her worry, and I've heard other anecdotes as well. It doesn't make much sense to me that hospitals wouldn't be able to find cost savings somewhere, but they'll probably do so by laying off staff. I think my mom's worry is that in the meantime some hospitals might flat out refuse Medicare patients, as I've read that some refuse Medicaid ones for the same reasons. Basically this, but not due to sequester, just due to Medicare limits: http://www.washingtonpost.com/blogs...-the-sequester/ It's a bit complicated, hospitals have a lot if fixed costs and a lot of various revenues. So, if for example, a hospital turns away a Medicare/Medicaid patient because they will be reimbursed less for an MRI than they would by a private plan, have they "saved money"? No, because they already had to pay for the MRI and they still have to pay the nurses and technicians regardless of whether they saw anyone or not. So their best bet is to make sure they're completely booked with people, even if some of those people don't pay as much as other people. Kind of like a hotel that takes on customers for a fraction of the normal price because empty rooms generate no revenue. It's possible that if all patients paid the Medicare rate, that hospitals could not afford to function as they do now. But this is a silly hypothetical because we aren't likely to see Medicare-For-All any time soon; and even if we did Congress would almost certainly step in and make sure Medicare rates were set high enough to ensure that hospitals didn't start closing their doors. And the same could be said here, really. If it turns out that hospitals refuse Medicare and Medicaid patients, Congress will likely act. In fact, PPACA already increased Medicaid to match Medicare reimbursements for 2013 and 2014; and I kind of expect this to be extended like a "Medicaid Doc-Fix" going forward. Though it's not guaranteed. quote:And speaking of exchanges, I just saw an article stating that exchanges wouldn't have more than one plan on them until 2015 (a year delay). I'm not sure how true this is or its ramifications, though. http://www.nytimes.com/2013/04/02/us/politics/option-for-small-business-health-plan-delayed.html?_r=0 An interesting article, thanks for posting this. Though to be clear, this article is referring to the SHOP exchanges where small businesses will purchase insurance for their employees. The Exchanges intended to sell to individuals do not seem to be effected by this. I suppose one possible fallout of this is that small businesses will just say "gently caress it" and let their employees use the individual Exchanges and the SHOP Exchanges may end up being dead on arrival. But its really hard to say right now if this will matter much in the long run. EugeneJ posted:Are the premiums you pay to an exchange going to be deducted from your wages, or will you have to pay a third party? I believe you'll setup payment through the Exchange. Most likely, what kind of options there will be (pay online, monthly auto-pay, paycheck deduction) will depend on how each state sets up their Exchange. oilcheck my rear end posted:Isn't there a federal non-profit option or some such if the state refuses to run its own exchange? If the states refuse to run its own exchange the Federal government will run one for them. I also think ALL Exchanges will be required to include two insurance plans sold throughout the entire country, chosen by the DHHS, one of which must be a non-profit plan. So you're kind of combining two different ideas. Also, I'm not 100% certain about the second part (national, non-profit plan). I remember reading about it, but I haven't found anything recently that I can point to as a definitive source on the issue. Sarion fucked around with this message at 02:59 on Apr 5, 2013 |
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Apr 5, 2013 02:57
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Sarion posted:It's a bit complicated, hospitals have a lot if fixed costs and a lot of various revenues. So, if for example, a hospital turns away a Medicare/Medicaid patient because they will be reimbursed less for an MRI than they would by a private plan, have they "saved money"? No, because they already had to pay for the MRI and they still have to pay the nurses and technicians regardless of whether they saw anyone or not. So their best bet is to make sure they're completely booked with people, even if some of those people don't pay as much as other people. Kind of like a hotel that takes on customers for a fraction of the normal price because empty rooms generate no revenue. There are health care providers that run exclusively on Medicare funds. Medicare has a huge advantage in that it provides cash flow. They pay on time, in full. Private insurance pays late, in part. And while bill collection companies and credit agencies are happy to go after private individuals and small businesses, they are very reluctant to deal with Blue Cross or Humana. The military health care budget, for example, is limited to Medicare reimbursement (so they say) and has much better health outcomes than private medical centers. And ask a military retiree to choose between TRICARE, VA, and insurance , and they'll pick TRICARE just about every time. Sarion posted:An interesting article, thanks for posting this. Though to be clear, this article is referring to the SHOP exchanges where small businesses will purchase insurance for their employees. The Exchanges intended to sell to individuals do not seem to be effected by this. I suppose one possible fallout of this is that small businesses will just say "gently caress it" and let their employees use the individual Exchanges and the SHOP Exchanges may end up being dead on arrival. But its really hard to say right now if this will matter much in the long run. For some reason, Congress hasn't been willing to increase funding for ACA activities since 2010. So like the BHP, SHOP was dropped as a "nice to have, but not essential." Small business will get some sort of SHOP support in the states willing to do a little extra to support robust heatlh exchanges. Sarion posted:If the states refuse to run its own exchange the Federal government will run one for them. I also think ALL Exchanges will be required to include two insurance plans sold throughout the entire country, chosen by the DHHS, one of which must be a non-profit plan. So you're kind of combining two different ideas. Also, I'm not 100% certain about the second part (national, non-profit plan). I remember reading about it, but I haven't found anything recently that I can point to as a definitive source on the issue. OPM defined plans for federal employees (who work in all states and territories) can be made available if the local plans and insurance departments can't get their act together. Interestingly, OPM has more experience with private health insurance than DHHS/CMS.
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Apr 5, 2013 04:47
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I wonder what they were thinking of when they set up the actuarial value of the bronze, silver, gold and platinum plans. I think that the average employer-provided plan has an actuarial value of 87%, or around there, which is nearly platinum, so a lot of people are going to be surprised by the high cost-sharing in the exchange's individual market health insurance plans. Bronze is 60% AV, Silver 70%, Gold 80%, Platinum 90%. Here is an example of a 60% AV benefit structure: $4,750 deductible Then the enrollee pays 20% coinsurance $6,250 out of pocket maximum And 70% AV: $2,200 deductible 20% coinsurance $4,200 out of pocket maximum And an 80% AV plan with only co-pays: $0 deductible $15 generic rx $40 preferred brand rx $50 primary care visits $60 specialist visits / mental health visits / Imaging (CT/PET/MRI) / Rehab visits / Laboratory outpatient / X-rays and diagnostic imaging / non-preferred brand name drugs $80 specialty rx $100/day skilled nursing facility $150 emergency room visits $700 per admission hospital inpatient $4,000 out of pocket maximum And a 90% AV plan with only co-pays: $0 deductible co-pays are 50% of what they are in the gold plan $1,200 out of pocket maximum Even the gold plan has high cost-sharing. What do they mean by calling 80% actuarial value "gold"?
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Apr 5, 2013 05:40
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The average plan in the individual market (i.e. the majority of people who will be on the exchange in 2014) is well below bronze level. It's just a marketing name and is easily recognizable. They could have called them Tall, Grande, Venti, Big Gulp.
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Apr 5, 2013 05:55
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esquilax posted:They could have called them Tall, Grande, Venti, Big Gulp. That was pretty hilarious, thank you. I read somewhere that the average person on the individual market has a plan with an actuarial value of 51%. That's a lot of people with plans that have something like a $10,000 out of pocket maximum. It's hard to believe.
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Apr 5, 2013 06:16
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Dr. Gaius Baltar posted:That was pretty hilarious, thank you. That's really what happens with adverse selection. Sick people, who anticipate having claims, want to buy plans with low deductibles. This means that those plans are unprofitable unless they have really high premiums. This leaves the only affordable plans as the ones that a sick person would never take. Plus, I'm guessing a lot of people don't actually know what a deductible is and just take the one with the lowest price tag. Hopefully the individual mandate, plus the subsidies, plus the regs, will help prevent this in the exchanges.
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Apr 5, 2013 06:26
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Cantorsdust posted:PPACA is a very frequent conversation topic at my med school. Pretty much every physician you talk to has a different opinion on what's going to happen, from "it's a good first step" to "the sky is falling and we're all going to be out of jobs." Part of the reason testing expenses are so high to begin with is due to practicing defensive medicine: covering your rear end by ordering tests to rule out the worst case scenario, not because you believe it's at all likely but because your career would be destroyed if you missed it. Paying per patient is going to strain that practice. I did some research on defensive medicine a few years ago as part of a discussion and I'm pretty sure that it's not as significant as it's made out to be. I wonder if being a medical student you have more up to date information than what I was working with: TehSaurus posted:Defensive medicine is the notion that a physician will change their clinical behavior to avoid exposure to malpractice claims. As you might suspect, it is nearly impossible to get a good picture of the true cost of defensive medicine. There are a couple of studies that survey physicians to try and get a grasp on how pervasive the issue might be. In one study 76% of 300 respondents claimed to alter their clinical behavior. In the other study it was 93%. However, neither study hazards a guess as to the actual cost of these deviations, since, given the nature of the work conducted it is impossible. This is where things get incredibly sketchy. There are only a couple numbers available for estimates in the cost of defensive medicine. The Department of Health and Human Services claims $126 billion in 2003, and Price Waterhouse Coopers claims $210 billion for 2008. These are significant numbers that add up to about 10% of all healthcare costs and make a compelling case for tort reform as cost control. The center piece of both claims is a study by Kessler and McClellan in 1996. The work of Kessler-McClellan relied on a set of data collected in 1984. The premise was that they would compare clinical practice in states with disparate tort laws. The work is widely criticized, but I think it is especially noteworthy that in 2004 the Congressional Budget Office was completely unable to reproduce similar results from the same data. Maybe that's outside the scope of this thread, but it doesn't seem to be moving incredibly fast. Basically, if there's not any better information on defensive medicine as a driver of healthcare costs, I want to illustrate that the real impact is unknown and probably overestimate.
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Apr 5, 2013 16:12
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Ender.uNF posted:The sheer amount of federal dollars Texas will miss out on will eventually drive us into accepting the expansion; it may take a few years though. Perry's gotta go for starters.
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Apr 5, 2013 17:16
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Sarion posted:Individual Mandate First, holy crap thank you for the well written and informative OP. I understand things a lot better now, and it's certainly helped to ease my vague fear of the unknown regarding PPACA. I wanted to make sure I understand the quoted part above. So if I meet all of the other criteria to qualify for the penalty and am uninsured throughout the entire year of 2014, I will be charged a $95.00 for the entire year ($42.50 if I start coverage in July)? Or will it be $95.00 per month, so $1140 for the year? Thanks in advance!
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Apr 17, 2013 18:33
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Mazzagatti2Hotty posted:First, holy crap thank you for the well written and informative OP. I understand things a lot better now, and it's certainly helped to ease my vague fear of the unknown regarding PPACA. I believe the totals there are yearly, but the penalty is accounted for monthly, hence the bottom line you quoted: quote:Also, the penalty is applied monthly. So if you have insurance for 7 months, and no insurance for 5 months, you pay 5/12ths of the penalty listed above. And if you are uninsured for 3 months or less, the penalty is waived. If you are uninsured throughout 2014, you owe $95 per person, up to $285 for a family OR 1% of income -- whichever is higher; if you are uninsured for 5 months, you owe $39.58 per person, up to $118.75 for a family OR 0.42% of income -- whichever is higher; etc. Not sure if that division applies to the upper limit or not, I extrapolated as though it does. e: Went to check the bill text to be certain, those totals are in fact yearly and the penalty is calculated monthly as a fraction of that total: SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE. posted:(2) MONTHLY PENALTY AMOUNTS.—For purposes of paragraph (1)(A), the monthly penalty amount with respect to any taxpayer for any month during which any failure described in subsection (b)(1) occurred is an amount equal to 1/12 of the greater of the following amounts: Mo_Steel fucked around with this message at 21:23 on Apr 17, 2013 |
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Apr 17, 2013 21:06
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Awesome OP, Sarion. I haven't had a chance to go through the info I've been collecting, but you covered the basics really well; thanks. You asked how premiums will be paid for Exchange plans. The money will flow directly from the government to the insurer, but will be detailed on the insurance invoice you get every month. E.g.: Say you're in an exchange, and your contribution toward health insurance is $100/month, with the government subsidizing it for an additional $300/month. The plan you choose under the Exchange will invoice you monthly, stating each portion to be paid (you and the government). So although the subsidies are technically a "tax credit" the true cost of the insurance is listed for you but all you're responsible for is your portion of the premium. Now, here's where it gets tricky, and creates a potential clusterfuck: Your portion of the premium is based on what's supposed to be current income--and if your income isn't static each year, as it might not be for freelancers or other self-employed people, you could find yourself owing taxes. Here's CJR's Trudy Lieberman explaining it: quote:Jost explained to reporters that the government will pay subsidies to insurers in advance each month, based on past and estimated future income. But the day of reckoning comes at the end of the year when the government will want to know if it overpaid on someone’s behalf. And that can easily happen. Said Jost: http://www.cjr.org/campaign_desk/chipping_away_at_health_reform.php The initial subsidies starting in 2014 will be based on 2012 income, since enrollment for exchange plans is in Q4-2013 (Oct-Dec of this year). But if you make more money, or have fewer deductions, in 2013 than you did in 2012, you're gonna get slammed with a tax bill that reflects the difference between the premiums you paid and the premiums you should have been paying. Also, you mentioned how the Act will encourage part-time employment (and I agree that it's Ugly). I just wanted to add that I've seen a lot of stories about how this is hitting grad students hard, with lots of university employers announcing cutbacks to classes-taught so they don't have to provide insurance to TAs. Also, the SHOP exchanges have been delayed for a year, till at least 2015. Willa Rogers fucked around with this message at 23:23 on Apr 17, 2013 |
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Apr 17, 2013 23:15
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mastershakeman posted:From what my aunt's been saying, her hospital loses money on the Medicaid patients and will possibly lose money on Medicare ones, as the rates they're allowed to bill doesn't cover their overhead. That's her worry, and I've heard other anecdotes as well. It doesn't make much sense to me that hospitals wouldn't be able to find cost savings somewhere, but they'll probably do so by laying off staff. A nursing administrator friend of mine told me that this varies based on the size and type of hospital. For very small hospitals that are the only one around in rural areas, they don't have to worry because they get higher reimbursement rates since (the reasoning goes) it would be really lovely if the only hospital in an area closed. Hospitals that are part of a big healthcare operation (i.e. the bigger players in metro areas of like over 100k people) also don't get hit that hard, but I don't remember her specifics of why. The places that have to worry are the ones like my friend works at, where they have one hospital and a couple clinics in a town of like 13k, but they don't get the bonuses for being in an underserved area, since they're either too big or too close to other towns/cities with adequate providers or something. This is all for non-profit hospitals, too. I don't think there are any for-profit ones in her area.
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Apr 18, 2013 00:49
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Thanks, Mo_Steel! With any luck I will have coverage by then and won't need to worry about this regardless. It's just good to know what I'm in for if not.
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Apr 18, 2013 11:58
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Okay, so I work full-time, and make enough to not be covered by the Medicaid expansion, but I'm eligible for a subsidy from the health insurance exchanges. My employer offers an "insurance" plan that is an absolute piece of poo poo and provides no meaningful coverage. I don't know if they are going to offer their employees real insurance in 2014 or if they are going to pay the fine, since they have many more than 50 employees. My state's exchange is run by the federal government. What exactly will happen in January 2014, and what do I need to do to get insurance and avoid paying the penalty? I follow this issue closely and I don't know, I'd say the vast majority of people won't have a clue. Is there any sort of plan in place to handle the massive bureaucracy needed to get everyone signed up, and educate everyone about what they need to do?
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Apr 18, 2013 15:55
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Konstantin posted:Okay, so I work full-time, and make enough to not be covered by the Medicaid expansion, but I'm eligible for a subsidy from the health insurance exchanges. My employer offers an "insurance" plan that is an absolute piece of poo poo and provides no meaningful coverage. I don't know if they are going to offer their employees real insurance in 2014 or if they are going to pay the fine, since they have many more than 50 employees. My state's exchange is run by the federal government. What exactly will happen in January 2014, and what do I need to do to get insurance and avoid paying the penalty? I follow this issue closely and I don't know, I'd say the vast majority of people won't have a clue. Is there any sort of plan in place to handle the massive bureaucracy needed to get everyone signed up, and educate everyone about what they need to do? Define 'an absolute piece of poo poo'. If it meets the requirements then you will not be able to get a subsidy on the exchange. Is your paycheck deduction less than 9.5% of your income? Open enrollment for the exchanges should start around October, and you'll probably see a big advertising blitz around then telling you what to do. No one really knows for sure yet, the bureaucrats have been terrible at getting regulations out in a timely manner.
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Apr 18, 2013 16:21
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quote:Encourages Part-time jobs That's not really clear. If an employer counts as a "Large" employer, then they have to offer a creditable insurance plan to their FTEs (the 25 people). (Actually isn't it 95% of the FTEs?) If some of those 25 people are not offered such a plan and go to the exchanges for a subsidised plan, then the employer would be fined. It is true however that it's in the employer's interest to make sure that the 100 part time employees really do stay part time, but that's an accounting problem that's the employer's responsibility to solve. If any of those employees turn out to actually be full-timers under the look-back analysis, then the company is liable for a penalty. One of the things that's likely to happen is that employers will learn to manage how they allocate work hours to part-time employees. For retailers, that'll mean that during busy times of the year, extra hours may go only to those hourly employees who've already crossed the line into full-time, or the hours will go to temporary workers. Part time employees who aren't offered plans by their employer can still go to the exchanges and are eligible for a subsidy.
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Apr 18, 2013 16:22
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emfive posted:That's not really clear. If an employer counts as a "Large" employer, then they have to offer a creditable insurance plan to their FTEs (the 25 people). (Actually isn't it 95% of the FTEs?) If some of those 25 people are not offered such a plan and go to the exchanges for a subsidised plan, then the employer would be fined. The employer is 'fined', but the maximum fine is $0 since it is calculated as $2000 per fulltime, exempting the first 30 fulltimes. That's my understanding anyway, not sure where you got your 95% number.
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Apr 18, 2013 17:16
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esquilax posted:The employer is 'fined', but the maximum fine is $0 since it is calculated as $2000 per fulltime, exempting the first 30 fulltimes. Ah OK, I see. The 95% thing: The IRS posted:After further study and consideration of the comments, the Treasury Department and the IRS believe that they should exercise their administrative authority to allow recognition of a margin of error consistent with an intent to recognize the possibility of inadvertent errors together with the specificity and administrability of a specific percentage, and therefore have concluded that a clear and definitive 95 percent standard would be an administrable and appropriate interpretation of the statutory provision. Accordingly, the proposed regulations provide that an applicable large employer member will be treated as offering coverage to its full-time employees (and their dependents) for a calendar month if, for that month, it offers coverage to all but five percent or, if greater, five of its full-time employees (provided that an employee is treated as having been offered coverage only if the employer also offered coverage to that employee's dependents). The alternative margin of five full-time employees (and their dependents), if greater than five percent of full-time employees (and their dependents), is designed to accommodate relatively small applicable large employer members because a failure to offer coverage to a handful of full-time employees (and their dependents) might exceed five percent of the applicable large employer member's full-time employees. D. Section 4980H(a) Relief for Failure To Offer Coverage to a Limited Number of Full-time Employees
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Apr 18, 2013 18:23
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What a bizarre and complicated way to "reform" the healthcare system. Will it be a disaster, or will things mostly stay the same with regard to insurance companies and hospitals screwing over patients in pursuit of obscene profits?
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Apr 18, 2013 18:36
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emfive posted:Ah OK, I see. Ah. The 95% thing is actually very complicated and only applies under certain scenarios. It's a bit important for calculating the penalty that the employer pays, but employers will generally pay ay least some penalty if even one of their employees does not get coverage.
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Apr 18, 2013 19:01
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HHS has released new drafts of the health-insurance applications; they look pretty straightforward and easy to fill out (although there's bound to be grumblings about some of the questions). Here's the the form to enroll families, and here's the application those with no dependents. I don't see a line item for partnership income on the financial portion of the app (the long form has a line item for rental/royalties), but I guess that would go under "other" income. One thing I asked about in BFC, but no one answered, was how net-income for obtaining subsidies or Medicaid determined; it's some form of modified AGI (or MAGI), but I'm not sure how it's calculated. According to the app, student-loan payments, alimony payments, and "other deductions" are subtracted from income when determining subsidie. That's kind of fuzzy; does it include, say, contributions to retirement plans? In all, though, the apps look like they'll be easy enough for most people to fill out, and there's also oodles of money going to facilitators, insurance agents and community organizations to help people enroll.
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May 1, 2013 07:50
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Willa Rogers posted:HHS has released new drafts of the health-insurance applications; they look pretty straightforward and easy to fill out (although there's bound to be grumblings about some of the questions). I wouldn't say that those questions are particularly hard to answer, but I was surprised by how many questions there were. It's easier to file taxes than to fill out that form, and tons of people end up having problems with their taxes. H&R Block might have more to do in the off season if that's the final form.
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May 1, 2013 13:51
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OwlBot 2000 posted:What a bizarre and complicated way to "reform" the healthcare system. Will it be a disaster, or will things mostly stay the same with regard to insurance companies and hospitals screwing over patients in pursuit of obscene profits? It won't be a disaster- at least not more of a disaster than the pre-PPACA system was. The bill extends coverage to some 16 million people who wouldn't have had coverage before. Even if it's crappy and/or expensive for them, it's markedly better than being totally uninsured against health costs in modern America. The bill's cost-containment measures were mostly negotiated away during the bill's formulation. So skyrocketing health care costs will continue to be a problem in the future. It certainly is a hodgepodge of a bill, with lots of objectively terrible policy in it. That's intentional- a more coherent and ambitious reform effort would have been less likely to pass Congress. At least this way they can still "reform the reform" later on down the line to deal with cost control- or that's the idea, anyway.
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May 1, 2013 16:06
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Is the 16 million the number of new medicaid enrollees plus the people who couldn't receive insurance due to pre existing conditions? Or does it include those who went without insurance not in those categories who have to get it now?
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May 1, 2013 16:57
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mastershakeman posted:Is the 16 million the number of new medicaid enrollees plus the people who couldn't receive insurance due to pre existing conditions? Or does it include those who went without insurance not in those categories who have to get it now? 16 million is the consensus estimate I've seen bandied around journal articles, but I'll admit I don't know exactly how it's calculated. But if it only included the former then it would certainly be an underestimate; I'm sure they accounted for people who (e.g.) couldn't afford individual insurance plans before but can now, or people who could have afforded an individual plan but chose not to (I don't see any viable way to reliably distinguish the two on an aggregate statistical level). Of course it all depends on how PPACA's implemented, how many states buy in, the extent to which Republicans/insurers can sabotage it going forward, etc, so I doubt anyone's married to the 16 million figure.
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May 1, 2013 17:11
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Part of the original numbers I believe also assumed in a sane world every state would expand Medicaid. America does not live in a sane world.
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May 1, 2013 17:14
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Here's a question: How does the PPACA effect veterans that're on disability (low percentage) and receive free health care for life at the VA? Does this count as already having health care and negate any fines?Amused to Death posted:On the subject of Medicaid and the states, here's a nifty map of where the states currently stand. gently caress Rick Perry. Sarion posted:Encourages Part-time jobs Didn't this hit the news wires when Papa Johns' CEO was saying he would be cutting hours, or firing people or something last year? I've got a friend that manages an O'Reilly in Houston and he said the company heads told him he has to keep every employee's hours below 29 and he's rather pissed off. Doe anyone this that it is actually a viable strategy for these companies to be so cynical? Don't you tend to lose the best possible employees when you restrict hours like that and end up having to spend a bunch in turnover costs? I was actually going to work for him over the summer between semesters, but at that rate it's a waste of my time. Sir Tonk fucked around with this message at 18:11 on May 1, 2013 |
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May 1, 2013 18:08
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