Patient Protection and Affordable Care Act — Page 3

I have a sinking feeling they've both left the building.

If you wanted to be super technical, Joe, the USPS does receive an indirect subsidy by borrowing from the US Treasury to pay off years of retiree obligations. So the question really becomes "does borrowing from the government to avoid defaulting on certain obligations count as a taxpayer subsidy since we'll eventually get that money back?" I'm in no way supporting the troll but all of the facts need to be put out there..

Yes Liza- I didn't deny there was a subsidy, I asked Sue to tell us what it was. With an annual budget of around $69 Billion (that was 2006- didn't bother to find a more recent one) the value of that pittance hardly accounts for Fed Ex charging 26 times as much (or more).

And Fed Ex picks and chooses where it delivers to an USPS is mandated to deliver to every single American whether in rural Appalachia or a military base in Guam....Oh well.

Updated On: 9/27/13 at 07:09 PM

And Fedex like countless other corporations pays into a pension insurance fund managed by the same feds which seem to be anathema to some on here,e.g. Pension Benefit Guaranty Corporation (http://www.pbgc.gov). If the feds are good enough to manage the pension insurance pool of the Fortune 500, I'm certain they'll stay on top of ACA implementations and disbursements in partnership with participating states. The insurance industry has never shown any affinity for self-regulation and an increasingly mobile population crisscrosses state borders all the time now.
Information About the FedEx Freight Pension Plan

---

"As far as I know, my insurance won't be affected. My boyfriend's insurance won't be affected. My best friend who works for the USDA won't be affected."

The problem is that the employer mandate has been delayed by a year, so those of us who are covered by our employers' plans won't know if our current plans will be affected or not for another year. Many employers have already announced that they are ending offering their own healthcare policies and forcing people (current employees and/or retirees) into ACA exchanges.

My current healthcare plan is excellent - low premiums, low deductible, I can see any doctor. If I am forced into an ACA exchange in 2015, my premiums will go up (according to reports that I have read), my deductible will go up (and dramatically), and it is likely that a lot of doctors will not accept ACA patients. I've been following the expected costs that people are expected to incur under ACA, and I think it's going to be a real eye-opener. Those of us who have good healthcare plans are in IMO, in for sticker shock in the future. I am pretty sure that I will be losing my Cadillac policy and will be forced into the exchange in 2015.

Updated On: 9/28/13 at 03:48 AM

Lauren I think it's important to point out: IF your employer ends your coverage, that has everything to do with your employer and nothing to do with the ACA. Employers make all sorts of changes to benefits packages all the time. If your employer ends your coverage, at least you'll have a reasonable alternative.

Well no Liza, an employer may BLAME it on the ACA but there is nothing in the law that makes it easier or beneficial or required or whatever that an employer discontinue coverage for employees.

I had an employer discontinue health insurance in 1991. And was I screwed.

I guess I'm still confused- The ACA doesn't really apply to your 5-man office, right? So no change there. Why would an employer who WAS offering coverage (voluntarily) dissolve his plan just because this gives non-insured other options? And it gives those folks who DON'T get offered employer plans (or the self-employed, like you) coverage that is much cheaper than is available now.

What am I missing?

Yes, Liza!

For humanitarian reasons, I wouldn't deliberately leave the employees in the lurch but starting on Oct 1 they will have the option of enrolling in the individual exchange here in MD. I also know of far too many small restaurant owners who have never and never will offer their employees health insurance, especially the ones who pay out of pocket to employees who are UNDOCUMENTED WORKERS.

Also, my physician-buddy whom I lit into recently has convinced me that I overreacted and overlooked the fact that his two physician partners and he are themselves small business owners with a staff of 15 medical professionals and para professionals along with the attendant headaches which he claims ACA is causing them.

Back to my scenario Joe, the three sticking points are the following:
(1) business owners are not included in the ACA employee headcount for tax credits but most small business (including me most likely) cannot afford to take a a salary the first year in business to attract the kind of talent that it takes to be competitive these days depending on the line of business, and
(2) if I gotta hold salaries to $50k a year for covered employees just to get the all important ACA tax credit, it's not prudent for me to provide the coverage at all; I could lower operating expenses by eliminating the perk and directing employees to the exchange
(3) initially SHOP participants would be entitled to pick from an array of health plans allowing employees to pick their preferred insurance carrier while paying a stipend to the exchange manager. However, there was a change after the ink dried limiting small business SHOP participants to a single insurance carrier in states that manage their own exchange like MD.

The long and short of it is that individuals get all the love in ACA and rightly so. But, the White House arguably oversold the ACA provisions for small-businesses and self-employed individuals where tax credits are concerned. Small business owners (including medical practitioners) were looking for a simplified arrangements that would bring their premiums for employee health plans down to level comparable with larger businesses. According to Michele Malkin, scores of self-employed business owners, trade groups, and industry guilds have been receiving so-called death notices from their health insurer informing them that their plans would not be renewed in Jan 2014 for non-ACA-compliance.

Back in April, Sara Kliff wrote a piece in WaPo which didn't generate that much buzz. Nevertheless, she did a much better job explaining the issues with SHOP than I (or Michele Malkin) ever could. I suspect that small businesses that pay an average salary of $50k are busy sending out notices if they haven't done so already. And I still don't fully understand the penalty for small businesses with revenue exceeding $500k that don't have ACA-compliant plans in place 2014.

This thread has been very beneficial to me at least.
Reports of the small business exchange’s death are greatly exaggerated

---

I am sorry to say but the medical field has become too bloated. There are way too many unnecessary tests and procedures. And do you really need to see a doctor only to be told that your tests are normal ? Could not some things be handled on the phone/online ? Do you really need to see a doctor for every minor complaint, instead of seeing a nurse practitioner ? And on and on and on. If ACA forces necessary cutbacks, it's a good thing, although I am sure very painful to those in the field. The growth in health care spending has become unsustainable.

Excerpt from the link Joe provided:

"If you have fewer than 50 full-time equivalent (FTE) employees, you are not subject to the Employer Shared Responsibility parts of the law. You may use SHOP to offer coverage for your employees."

The rub is that SHOP was created as a 'voucher' program for small business owners that employ low-wage employees. The promise to small business was that ACA/SHOP would level the playing field allowing them to get affordable insurance premiums to cover employees rivaling what has traditionally been offered to large corporations, federal/state/municipal government health plans, labor unions, and major trade groups. Small business had been paying through the nose for paltry coverage with a limited selection of carriers willing to cover such a small pool.

ACA/SHOP sets a cap of $50k on the average salary of a small business to qualify for the federal tax credit on up to 50% of the small business health care expenses which for the most make up a huge part of the cost of doing business. OWNERS can NOT be counted in the headcount which eliminates the SELF-EMPLOYED. Now that many current small business owners see ACA/SHOP for what it is they are likely to give up on trying to find better coverage on their own, terminate their employer plans, and either go in the exchange for group coverage or pay a 'voucher/stipend' to employees to get their own coverage in the exchange. Startups are going straight to the exchanges.

I can't think of a doctor's office, law firm, or engineering firm in the area with an average salary of $50k or less so the professional service sector gets the shaft. ACA expands Medicaid in states that are managing their own exchanges so doctors in those states will have to potentially care for even more patients while receiving even smaller reimbursements from the exchanges. I agree with Liza's assessment that medical practitioners are the forgotten group in all of this.

And I have a cousin who's the managing partner of a mid-size DC law firm. She joked earlier today that the only folks benefiting from ACA will be the attorneys suing the exchanges or the ones defending them. Her firm will not be hiring associates in the spring for the first time in its 15-yr history.

No one is going to sign with my firm if I can't offer a base salary well above $50k and comprehensive health insurance that includes coverage for SPOUSES and DEPENDENT CHILDREN. ACA/SHOP would not be the preferred option for me as a business owner since I wouldn't qualify for the tax credit but it would most likely be cheaper than private health insurance. I never thought I'd agree with Michelle Malkin in a million years but I think she got it right with respect to the ACA and the self-employed. It's clearly a blessing for the uninsured or under-insured individual but it leaves something to be desired for small business owners that don't operate a low-paying sweatshop and the self-employed.









Obama Lied, My Health Plan Died

---

Updated On: 9/28/13 at 08:05 PM

If the cap on average salaries for the tax credit had been based on median household income or per capita income in a COUNTY, the metric would seem more reasonable. But, to me at least that $50k figure seems completely arbitrary. I live in Montgomery County, MD where the costs of labor and commercial rents are astronomical. I'm sure there are better sources but Wikipedia will do in a rush.
List of U.S. states by income

---