Good news, liberal-arts majors with Internet connections! Now even though you don't have a "real job" but are making a livable amount of money by cobbling together three blogging gigs and so don't have health insurance, starting in 2014 you will be able to (and also required) to stone-cold buy health insurance from whoever you want --
There was never any compulsion to set up an exchange, but there was the provision that wherever states opt out of creating exchanges, the Federal government will step in and create one the state has no control over. In other words, you can have it how you want it, or how we want it, your choice, but you're fucking getting it.
Anyone for whom their contribution to the cheapest plan in the Exchange is over 8% of household income is exempt from the penalty.
The amount of the penalty if you are not exempt is at least $95 per year per non-covered person* in 2014, ramping up to at least $695 per year per non-covered person by 2016 and inflation-linked thereafter. If your income is sufficient that 1% (in 2014) of income exceeds the fixed amount, ramping up to 2.5% of income by 2016, you will pay that fraction of income.
However, if you would've been eligible for Medicaid, you should never pay the penalty (except maybe in 2014 or 2015, depending on exact income level). Your income would've been no more than 133% of Federal Poverty Level, so let's look at what that means in terms of Exchange subsidies. In the Exchange, you'd receive a subsidy of the difference between the second-cheapest silver level plan (plans are bronze, silver or gold) and 2% of your annual income - in other words, you'd have to pay no more than 2% of income to get a decent level of coverage, and that's less than the penalty will be in 2016. What's more, because the subsidy is based on the silver level, there's a good chance that you'd be able to get a bronze-level plan fully covered by the subsidy.
Now, bronze-level coverage leaves you having to foot quite a lot of the bill if you ever actually <em>use</em> it, probably more than you can afford if your income is low enough you would&#039;ve qualified for expanded Medicaid if your state wasn&#039;t run by jackasses, so it might not be a tremendous value to you, but at least it&#039;ll prevent you from being penalized.
If you&#039;re in the window where the subsidy doesn&#039;t cover the full cost of bronze care and you can&#039;t afford to pay <em>anything</em> in premiums, you&#039;ll have to write the Secretary of HHS and beg a hardship exemption. Better hope there&#039;s a Democrat in office, or the response will be &quot;you have a refrigerator, don&#039;t you?&quot;
AND THE BOTTOM LINE, FOLKS, IS THAT MEDICINE/PHARMA AS IT IS TODAY IS THE NUMBER ONE KILLER OF AMERICANS.
I&#039;m sorry, but that&#039;s nuts. The number one cause of death for Americans is still cardiovascular disease and stroke, unless I&#039;m mistaken, and number two is lung cancer. &quot;Medicine/pharma&quot; does not cause cvd or lung cancer. Indeed, one of the reasons I&#039;m 64 and still haven&#039;t had my first heart attack, despite my fondness for red meat, is atorvastatin.
Now, if you&#039;re suggesting that there is a problem with universal access to MEDICINE/PHARMA, and people grow ill and die because of lack of access, I&#039;d agree with that. But, then I applaud the greater access granted by the ACA, while you appear to think it&#039;s a bad (or meh) idea.
Medical Loss Ratio (MLR). The insurance companies are (generally) required to maintain an MLR of at least 85%, which means that at least 85% of their premium income must be used as reimbursements to actual health care providers (or they have to return the shortfall to the subscribers).
Arguably, they could negotiate less favorable rates with providers to increase the reimbursement and hence their 15% rake-off, but at least in such a case the providers would be getting most of the benefit. Also, unless they did it via illegal collusion, an insurer who bucked the trend and kept premiums down could grab market share.
As always, the tricky bit id preventing (or at least detecting) the illegal collusion.
What really gets me is that current Medicaid eligibility rules are impenetrably complicated. If you have kids under 6 then this, if you&#39;re blind then that, if you&#39;re disabled but still working the other, if you&#39;re pregnant something else, if you have kids over 6 a different set of rules again; plus whatever the state you&#39;re in chooses to add. The ACA swept a big chunk of that away with the \"if your family is under 133% of FPL, you&#39;re eligible\" rule. Which makes the people whining about implementation costs really irritating - the streamlining of eligibility rules would substantially reduce the administrative burden going forward.<br /><br />SC actually does a vastly better job of explaining their rules than NY does, I looked at the NY rules to try to work out who would be affected by the GOP&#39;s (I think ultimately successful) attempt to count 100% of Social Security income instead of 50% when determining Medicaid eligibility, as a \"pay-for\" for something or other I can&#39;t remember exactly what. The \"savings\" the GOP sought of course actually translated mostly to two things: kicking grannies out of their nursing homes, and preventing the permanently disabled from accessing ongoing care. Anyway, NY didn&#39;t have any plain-English materials I could find, and I quickly gave up even trying to make head or tail of the legislation.<br /><br />Under the Exchange&#39;s subsidy calculation, the highest contribution anyone who was intended to be covered by the Medicaid expansion would be asked to make for the second least-expensive silver plan would be $16.67 to $24.77 per month. I can almost guarantee the difference between a bronze and a silver level plan will be more than that, the difference between roughly comparable levels of coverage through my large-group employer plan is about $100/mo, so it&#39;s very likely that anyone who got screwed out of Medicaid eligibility by having the misfortune to live in a state run by vindictive fuckheads would be able obtain coverage that&#39;s fully paid for by the subsidy. The out of pocket expenses would be much higher than Medicaid, but it might be easier to find a Doctor, and at least (A) you&#39;d avoid the penalty, and (B) you&#39;d have access to covered preventative services at no charge. So, still a meaningful improvement over the pre-ACA situation, even if it falls substantially short of what the ACA was intended to achieve.
As hard as this will be for the poors in the short run, I see a positive with this. First, it will highlight in an even clearer light just who the unutterable shitheels are. Second, for those governors who trend towards unutterable shitheel, it will either force them to ignore their teabag base or go full Galt. Neither path will help in their respective re-elections.
Well, Mitts does have at least one avenue open to him as we head into the fall: screaming &quot;It&#039;s a tax! He raised our taxes!! It&#039;s the biggest tax increase in our Exceptional Nation&#039;s history!!!&quot;
Exactly what I was thinking. The conventional wisdom seems to be that this court decision will rally conservatives to unify behind Mittens, but haha! He wrote the whole fucking thing first. Sorry Poors, and imma let you finish, but this court made the best decision of all time!
actually i think he was a bit of a coward. he voted against his own (likely) opinion to ensure that his court wasn&#039;t remembered as the 21st dred scott.
Repub. state senator is a drooling moron.
There was never any compulsion to set up an exchange, but there was the provision that wherever states opt out of creating exchanges, the Federal government will step in and create one the state has no control over. In other words, you can have it how you want it, or how we want it, your choice, but you&#039;re fucking getting it.
Anyone for whom their contribution to the cheapest plan in the Exchange is over 8% of household income is exempt from the penalty.
The amount of the penalty if you are not exempt is at least $95 per year per non-covered person* in 2014, ramping up to at least $695 per year per non-covered person by 2016 and inflation-linked thereafter. If your income is sufficient that 1% (in 2014) of income exceeds the fixed amount, ramping up to 2.5% of income by 2016, you will pay that fraction of income.
However, if you would&#039;ve been eligible for Medicaid, you should never pay the penalty (except maybe in 2014 or 2015, depending on exact income level). Your income would&#039;ve been no more than 133% of Federal Poverty Level, so let&#039;s look at what that means in terms of Exchange subsidies. In the Exchange, you&#039;d receive a subsidy of the difference between the second-cheapest silver level plan (plans are bronze, silver or gold) and 2% of your annual income - in other words, you&#039;d have to pay no more than 2% of income to get a decent level of coverage, and that&#039;s less than the penalty will be in 2016. What&#039;s more, because the subsidy is based on the silver level, there&#039;s a good chance that you&#039;d be able to get a bronze-level plan fully covered by the subsidy.
Now, bronze-level coverage leaves you having to foot quite a lot of the bill if you ever actually <em>use</em> it, probably more than you can afford if your income is low enough you would&#039;ve qualified for expanded Medicaid if your state wasn&#039;t run by jackasses, so it might not be a tremendous value to you, but at least it&#039;ll prevent you from being penalized.
If you&#039;re in the window where the subsidy doesn&#039;t cover the full cost of bronze care and you can&#039;t afford to pay <em>anything</em> in premiums, you&#039;ll have to write the Secretary of HHS and beg a hardship exemption. Better hope there&#039;s a Democrat in office, or the response will be &quot;you have a refrigerator, don&#039;t you?&quot;
AND THE BOTTOM LINE, FOLKS, IS THAT MEDICINE/PHARMA AS IT IS TODAY IS THE NUMBER ONE KILLER OF AMERICANS.
I&#039;m sorry, but that&#039;s nuts. The number one cause of death for Americans is still cardiovascular disease and stroke, unless I&#039;m mistaken, and number two is lung cancer. &quot;Medicine/pharma&quot; does not cause cvd or lung cancer. Indeed, one of the reasons I&#039;m 64 and still haven&#039;t had my first heart attack, despite my fondness for red meat, is atorvastatin.
Now, if you&#039;re suggesting that there is a problem with universal access to MEDICINE/PHARMA, and people grow ill and die because of lack of access, I&#039;d agree with that. But, then I applaud the greater access granted by the ACA, while you appear to think it&#039;s a bad (or meh) idea.
Evidently, one of us is insane.
I assume you refer to his statement that he wouldn&#039;t bother to read the ACA because it was too goddam long.
Medical Loss Ratio (MLR). The insurance companies are (generally) required to maintain an MLR of at least 85%, which means that at least 85% of their premium income must be used as reimbursements to actual health care providers (or they have to return the shortfall to the subscribers).
Arguably, they could negotiate less favorable rates with providers to increase the reimbursement and hence their 15% rake-off, but at least in such a case the providers would be getting most of the benefit. Also, unless they did it via illegal collusion, an insurer who bucked the trend and kept premiums down could grab market share.
As always, the tricky bit id preventing (or at least detecting) the illegal collusion.
What really gets me is that current Medicaid eligibility rules are impenetrably complicated. If you have kids under 6 then this, if you&#39;re blind then that, if you&#39;re disabled but still working the other, if you&#39;re pregnant something else, if you have kids over 6 a different set of rules again; plus whatever the state you&#39;re in chooses to add. The ACA swept a big chunk of that away with the \"if your family is under 133% of FPL, you&#39;re eligible\" rule. Which makes the people whining about implementation costs really irritating - the streamlining of eligibility rules would substantially reduce the administrative burden going forward.<br /><br />SC actually does a vastly better job of explaining their rules than NY does, I looked at the NY rules to try to work out who would be affected by the GOP&#39;s (I think ultimately successful) attempt to count 100% of Social Security income instead of 50% when determining Medicaid eligibility, as a \"pay-for\" for something or other I can&#39;t remember exactly what. The \"savings\" the GOP sought of course actually translated mostly to two things: kicking grannies out of their nursing homes, and preventing the permanently disabled from accessing ongoing care. Anyway, NY didn&#39;t have any plain-English materials I could find, and I quickly gave up even trying to make head or tail of the legislation.<br /><br />Under the Exchange&#39;s subsidy calculation, the highest contribution anyone who was intended to be covered by the Medicaid expansion would be asked to make for the second least-expensive silver plan would be $16.67 to $24.77 per month. I can almost guarantee the difference between a bronze and a silver level plan will be more than that, the difference between roughly comparable levels of coverage through my large-group employer plan is about $100/mo, so it&#39;s very likely that anyone who got screwed out of Medicaid eligibility by having the misfortune to live in a state run by vindictive fuckheads would be able obtain coverage that&#39;s fully paid for by the subsidy. The out of pocket expenses would be much higher than Medicaid, but it might be easier to find a Doctor, and at least (A) you&#39;d avoid the penalty, and (B) you&#39;d have access to covered preventative services at no charge. So, still a meaningful improvement over the pre-ACA situation, even if it falls substantially short of what the ACA was intended to achieve.
ken?
Josh you are harshing my buzz with your facts and stuff.
As hard as this will be for the poors in the short run, I see a positive with this. First, it will highlight in an even clearer light just who the unutterable shitheels are. Second, for those governors who trend towards unutterable shitheel, it will either force them to ignore their teabag base or go full Galt. Neither path will help in their respective re-elections.
Well, Mitts does have at least one avenue open to him as we head into the fall: screaming &quot;It&#039;s a tax! He raised our taxes!! It&#039;s the biggest tax increase in our Exceptional Nation&#039;s history!!!&quot;
Over and over again. Good luck with that, Mitts.
Exactly what I was thinking. The conventional wisdom seems to be that this court decision will rally conservatives to unify behind Mittens, but haha! He wrote the whole fucking thing first. Sorry Poors, and imma let you finish, but this court made the best decision of all time!
actually i think he was a bit of a coward. he voted against his own (likely) opinion to ensure that his court wasn&#039;t remembered as the 21st dred scott.