The differences are so fundamental, war cannot be avoided.
What Opponents of the ACA Say
This is an admittedly incomplete list, but here are the highlights.
ACA has failed, carriers have pulled out of exchanges.
People should not be forced to buy health insurance
Tax credit will create incentives for people to buy health insurance
Medicare is bankrupt, we need to address the Medicare along with the ACA
What Proponents of the ACA Say
This is an admittedly incomplete list, but here are the highlights.
ACA has succeeded, the number of uninsured is lower, which is the goal
Medicaid Expansion has greatly aided those that couldn't afford health insurance
Repealing the ACA Will Make the Problem Worse
Repealing the ACA Will Threaten Medicare
What is True, What is Not
The ACA is a tax. 100% true.
Let's be clear: the ACA is a tax. If you have been led to believe otherwise, and believed otherwise, then you are entirely mistaken. When the Supreme Court affirmed the legality of the ACA, it said so in a very elegant way. Basically, the Supreme Court majority opinion boiled down to "The ACA is a tax, and the government has the Constitutional right to tax. Repealing taxes is not a court's issue, it is the issue for elections."
Does the tax have a rationale? Yes, in much the same way that the requirement to purchase auto insurance has a rationale, the requirement to purchase health insurance has a rationale. The difference, however, is that the cost of the financlal downside to not having health insurance is MUCH larger, on average, than the cost of not having auto insurance. Simply ask a person with an incurable disease that has health insurance, "What would've occurred if you had not had health insurance?"
A tax credit can fix this. Uncertain.
The question is whether or not the proposed tax credit will create an incentive enough for people to purchase health insurance. For those who have severe medical conditions, the answer will be yes, because they are a buyer at almost any price. For those that are healthy, however, the answer is entirely uncertain, and it will depend on the rest of the tax code, the person's understanding of the financial downside, and his/her financial situation.
No "pre-existing condition" clause has made health insurance more expensive: 100% true.
Sellers (health insurance carriers) had to establish a price, stick to it, and it didn't matter how sick someone was, the seller had no choice but to accept every new policyholder. For those with astronomic medical expenses, this is a guaranteed loss for the seller. Even if 64.5 years old, a premium of $2000 a month would pale in comparison to the amount of benefits that the health insurance company would have to pay to doctors and/or hospitals. The problem here is that there were not enough healthy buyers to offset this loss. Whoever wrote the ACA didn't properly incentivize the health enough to buy health insurance, i.e. if anything, the tax penalty for not purchasing health insurance was too low.
We can fix this with "high-risk pools" or "reinsurance." Maybe, and 100% False, in that order.
This illustrates the inconsistency of logic. A "high-risk" pool would be created so that those with pre-existing conditions could still purchase health insurance. Really? If sellers are withdrawing from exchanges because they don't want to sell to those that "may be" sick, then why would they want to sell to those that are certainly sick, i.e. the people applying under the high-risk pool? A tax credit will not be high enough for these people.
The same complaints about the ACA (high cost, narrow networks) will occur. The exact same complaints that "prove" the opponents' points. The fact is that high-risk pools have existed in the past, and the problem with them was that the networks were narrow, and the cost high. That said, will that allow the healthy to purchase health insurance at lower premiums? Yes. Since the answers vary here, the answer is maybe.
Reinsurance cannot work. To review, reinsurance is "insurance on insurance." A health insurance company would itself buy insurance, to limit the downside to itself. The reason this cannot work is that if it could've worked, then it would've already existed. Why do we know this? The reason is that Wall Street would've created an investment (an asset-backed security), where the asset is the reinsurance. There are no natural buyers of this risk, because if there were, then Wall Street would've found them, and re-packaged the risk, and sell it to them.
Allowing Carriers to Sell in Multiple States Will Fix This. False.
This has been tried in the past, and didn't work, in Maine and Georgia. Why?
Building networks is not child's play. You have to get doctors, hospitals, and other healthcare providers to all agree to "sign up" to a network. Let's say you are a health insurance company in Texas. You don't have the resources to sign up and reach agreements with doctors and hospitals in neighboring Oklahoma, much less in Alabama. They have to agree to a way of being compensated for their services, while the cost of living will vary across regions. Let's say "they could calculate this." Really? They would also need to be able to correctly predict the number of policyholders, per location. Almost impossible. This alone is a death bell to this idea.
The only conceivable exception would be for the largest national carriers to execute this, because they already have people in place to reach out to healthcare providers. Even then, it isn't clear that the healthcare providers would agree in a scale large enough to create competition among multiple carriers.
The Number of Uninsured is Lower. True.
Does this matter? To hospitals, no doubt. They are required to serve patients, and fewer uninsured means a greater chance of being compensated. We can debate about the trees, but this is the forest.
The unanswered question is: has the lower number of uninsured meant that the costs to the system are lower? The problem that the supporters of the ACA have is that they cannot answer this question, which is an important one, because since the ACA is a tax, the question a taxpayer should rightfully ask, "what did I get for paying the tax?" The idea is that few uninsured will “bend the cost curve” so that overall, systematic healthcare costs will decline. Here is a question that the supporters have not answered.
Medicaid Expansion Has Been Helpful for Many. True.
This cannot be a debate. For those that live in states that implemented Medicaid expansion, the ACA has, in certain cases, made health insurance affordable to those that would not have been able to purchase it. For those who live in states that have not implemented Medicaid expansion, they have not reaped the obvious benefits.
Medicaid expansion recipients have received a) lower premiums, and sometimes, b) lower cost-sharing responsibilities (deductibles and out of pocket maximums). Point b) here is under immediate threat, with an answer coming in February (as of this writing).
Repealing the ACA Will Threaten Medicare. Uncertain.
I am an author of a book on Medicare, so turmoil here should create far greater demand for future editions of Maximize Your Medicare.The effect on Medicare will entirely depend on the nature of the changes. Here is a partial list of reasons.
IRMMA has resulted in higher Medicare Part B and Part D premiums for high-income earners
The ACA has mandated a narrowing of the Part D coverage gap, aka "donut hole."
Funds have been taken out of Medicare to pay for the ACA, will they be returned?
Proposals exist to overhaul Medicare by introducing "premium support," which is a voucher system, where individuals would use vouchers to privately purchase health insurance.
"Premium support" proposals would also dismantle the ability of the CMS to assign a price structure across healthcare services, i.e. Medicare Advantage would lose its ability to push down systematic healthcare costs. If you did this, then all m
Socrates Is Right: This War is Political
The logic runs that "The ACA is making Medicare go broke, so we need to look at everything together." That presumes that the solution will be better, and as you can read from this article, it is entirely unclear that a simple repeal of the ACA will make things better.
HERE IS THE PROBLEM. WE CANNOT GET AROUND THIS DIFFERENCE.
"People Should Individually Decide" Presumes This
• People understand the risk they face
• People understand the effect their choice has on others
The question is whether the general population is qualified to understand these, to make the proper determination? What is entirely rational for the healthy (to not buy, at almost any price), is not necessarily what will help the systematic healthcare cost structure. The problem here is that an unqualified decision here has costs to the overall system, the effect is NOT ONLY on the individual him/herself. The result is the vicious cycle we have at the moment. There is NO WAY to isolate these sides. NO WAY. The healthy go to the same physicians as the ill. The healthy go to the same hospitals as the terminally ill.
Those who cannot afford to pay, those who rely on government assistance go to the same hospitals. So the end result is that those that cannot pay, but require assistance, receive Medicaid. Medicaid is severely restrained, and therefore hospitals and doctors do not receive full payment for their services. Who do they charge? The ones that can afford it.
For those that believe that government exists to protect those that cannot decide correct for themselves, the ACA, warts and all, is necessary. For those that believe that people should be left alone to decide, the ACA must go. Both supporters and opponents are unlikely to convince the other.
Whether either side has completely, correctly understood the ramifications of their respective positions? That would be very difficult to believe.
My future recommendations on how people and companies will need to deal with the ACA, and its potential repeal, will be available only on GH2 Unfiltered, described below.
PPACA Repeal: The Updated Headlines
Here will be "what you need to know" about the potential repeal of the PPACA.
Here's What One of the Leading Think Tanks Thinks: Link
Selling Health Insurance Across States Didn't Work in Georgia: Link
Trump could quickly doom ACA cost-sharing subsidies for millions of Americans Link
Robert Reich claims Sen Ryan wants to repeal the ACA and Medicare: Video Link
It's Trump's turn to wrestle with reforming healthcare: Link
If You Receive the PPACA Tax Credit...Beware
You may have a problem, and soon.
There are actually 2 parts (not only 1) to the "Medicaid expansion," included for some, due to the PPACA.
The reduction in the monthly premium
Reduction in deductible and out-of-pocket maximium limit
The first of these require a law to be passes (to repeal). The second one, however, is entirely separate. It was a simple "add-on," and a lawsuit was filed by the GOP to repeal the second portion, as it called this portion illegal. And the GOP has won, and won again. This means that at this point, the second portion, which is funded by the US government, is under threat, right now.
Personal Finance Section
GH2 Benefits, LLC Client Portal
GH2 Benefits is the name of the professional services firm under which I privately operate. It can operate in virtually every location. The licensing and appointment process of financial services is irrational but they are rules we follow. We will give the same, expert information and advice to you, whether or not we earn anything from your decision.
Clients Can Send Us Information Privately
There are many rules regarding the use of private information: we are subject to them and follow them. There is a reason that our clients receive instructions to NOT include addresses, phone numbers, etc on emails that may also include other private information. On the Client Portal, you can send your documents to us securely.
It is clear: a lot of the application process will occur online. We are okay with this for a variety of reasons. Sometimes, people don't want to talk to a person. They want to investigate and execute privately. That is not a great idea for a variety of reasons (Maximize Your Medicare is a guide where the reasonable conclusion is "I have information so that I know what to ask, but ultimately, I need expert assistance to execute"). That is especially the case since we don't charge for the consult itself (yet).
Online Quoting allows you to apply online, and we will be able to be your representative, in case there are problems in execution, and after the fact, you can ask us questions if you have questions/problems/issues with your coverage.
We receive all sorts of random questions about different types of insurance matters. Travel, pet, dental, vision, you name it. We do keep track of what exists and the approximate price. You can see examples on the Online Quoting section in order to apply for yourself among the leading providers. We may or may not be affiliated with the carrier.
People ask what GH2 stands for? Great Hope, Great Humanity. Great Hope, so that you can do what you want, as best you can, Great Humanity is the way we treat every client, irrespective of personal, financial or private background.
GH2 Benefits will contact you in advance to ensure you don't miss deadlines
GH2 Benefits will resolve issues with all carriers (including the CMS) if you have issues
GH2 Unfiltered, an Online Newsletter
You can weed through the advertisements, publications, newspapers, magazines by yourself. Be my guest. What you will find is that the information is either wrongly described or so vague, that you cannot tell if the information that you receive applies to you at all.
GH2 Unfiltered is Similar to Maximize Your Medicare Maximize Your Medicare was written to point out specific features and language embedded in Medicare, retiree health benefits, Medicare Advantage and Medigap. The point is Medicare is health insurance, which is a financial contract. Within Medicare, there is specific language involved, just like any financial contract, and proper knowledge of that contract can make the entire difference, and entirely change the outcome, one way or the other.
If anything, Medicare is simple, the "shallow end of the pool." If you have been led to believe that Medicare is complicated and other financial contracts are easier, then I could not disagree more strongly. Other products are much more complicated because they are not regulated in the same way that Medicare is, i.e. the language isn't standardized at all, the restrictions are not clearly described in a way that everyday people can understand, the potential outcomes are not properly described to you. GH2 Unfiltered is created to address the other products that exist.
What Cannot Be Said in Public
Which product, why, which carrier. None of these are revealed in the Maximize Your Medicare Newsletter. There are reasons for this: the main one is that we need to make sure that we are not misunderstood, or that someone takes our comments out of context. We have opinions, and reasons for those opinions. The fact is that you receive a fragment of the information required to make decisions. Many of you ignore topics entirely because it seems too confusing to understand. A lot of the reason why? The explanations given are too vague or inadequate. As in the case of Medicare, that doesn't mean that the function of the product is unsuitable. In fact, products may suit you very, very well.
GH2 Unfiltered will include those opinions, about the products we have seen, and our evaluation of certain types of financial planning themes, and specific products. Here is a partial list:
Medicare & Individual Health Insurance
Other Insurance (Long-Term Care, Term Life, Whole Life)
Maximize Your Medicare (2017 Edition) with Audio Explanation
The full version of Maximize Your Medicare (2017 Edition) is included for reading on your computer, tablet and smartphone. There will also be a voiceover (it is kind of like the "Director's Cut" of movies on DVD, it is not a simple re-read of the text), separated into sections, on each chapter of the book. GH2 Unfiltered is the only place that the audio explanation of the book will be included.
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