# Obamacare questions **URL:** \ **Category:** Factual Questions\ **Created:** [November 11, 2012, 6:58pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697 "2012-11-11T18:58:57Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [November 11, 2012, 10:29pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/21 "2012-11-11T22:29:03Z")
> [@pkbites](#): > > Easy to do with the full employment the U.S. has, right? > > The health insurance I have cost $1600 a month. How does a guy in his 20’s making 40 grand a year pay for that on his own? Hey, I was (and am) for full on “socialist” Universal Health Care, man. This wouldn’t be a problem then. This wouldn’t have even been much of a problem if They would have allowed the Medicaid expansion through unchallenged. But the whole point of the exchanges is to offer plans for something a guy in his 20’s making 40 grand a year can pay for on his own, not to offer anothr $1600 a month plan. But we’ll have to see what the rates/plans are actually like. ---
**Author:** ![lazybratsche](https://avatars.discourse-cdn.com/v4/letter/l/ba8739/32.png) [@lazybratsche](https://boards.straightdope.com/u/lazybratsche)\ **Post date:** [November 11, 2012, 10:35pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/22 "2012-11-11T22:35:06Z")
> [@pkbites](#): > > The health insurance I have cost $1600 a month. How does a guy in his 20’s making 40 grand a year pay for that on his own? Insurance shouldn’t cost nearly that much. By setting up exchanges, and mandating that everyone gets coverage, you should be able to buy much cheaper insurance. Basically the risk pools will be much larger, and a lot of healthy people will pay into the system which reduces everyone’s premiums. Also, anyone below 4x the poverty line will get some amount of subsidy, basically capping your insurance cost at a certain percent of your income. In your particular example, a single dude making 40 grand is around ~3.5x the federal poverty line. [According to this table](http://en.wikipedia.org/wiki/File:PPACA_Premium_CRS.jpg), your maximum **annual** premium will be around $3600, for a plan that meets some minimum standards of coverage. ETA: By point of comparison, last time I had a regular job my annual health insurance premium was around $5k/year (mostly paid by the employer), for a pretty great plan. ---
**Author:** ![Kimmy\_Gibbler](https://avatars.discourse-cdn.com/v4/letter/k/bbe5ce/32.png) [@Kimmy\_Gibbler](https://boards.straightdope.com/u/Kimmy_Gibbler)\ **Post date:** [November 11, 2012, 10:37pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/23 "2012-11-11T22:37:36Z")
> [@jasg](#): > > I believe that the key factor is Household, as opposed to Family Income. > No change from current situation, Long Term Care is not a part of the ACA. However, since that may be too literal an interpretation of your use of ‘long term medical care’, they will be covered under the rules explained by Kimmy Gibler. Which means covered now under Medicaid, covered in future too. Well, both of these are not quite accurate. Sal is not covered today for three reasons: (1) as a childless non-disabled adult, he is categorically excluded from canonical Medicaid (but could categorically qualify in states with waivers), (2) the income of his parents (in whose household he resides) may be deemed as his as well, and (3) resources are also part of the eligibility calculus. For opt-in states (who will follow what I have called “canonical PPACA”), Sal will become categorically eligible. Deeming of other household members’ income will not occur. Resources are taken out of the calculus entirely. Grizzly Adams is a closer case. He also is not eligible for Medicaid today as he is a childless non-disabled adult. If, however, between now and Jan. 1, 2014, when expansion take effect, he becomes disabled (briefly, unable medically or psychologically to sustain substantial gainful employment on a full-time basis), he would become eligible. If his medical condition does not prevent him from be capable of sustaining full-time employment (a medical analysis and apart from the question whether he does so work and also somewhat apart from the question whether the condition of the economy allows him to find such work), he would not be eligible under current canonical Medicaid, but would be eligible under canonical PPACA. ---
**Author:** ![pkbites](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pkbites/32/204_2.png) [@pkbites](https://boards.straightdope.com/u/pkbites)\ **Post date:** [November 11, 2012, 11:13pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/24 "2012-11-11T23:13:51Z")
> [@lazybratsche](#): > > Insurance shouldn’t cost nearly that much. It’s a government plan. It’s beyond Cadillac insurance. More like Rolls Royce. Before I retired I paid $35 a month for it. Now I pay zip! > [@lazybratsche](#): > > By setting up exchanges, and mandating that everyone gets coverage, you should be able to buy much cheaper insurance. Basically the risk pools will be much larger, and a lot of healthy people will pay into the system which reduces everyone’s premiums. If this would work why didn’t insurance companies set this up years ago on their own? And what happens when this doesn’t work and the math on it turns out to be a fantasy? Either the system collapses or taxes get jacked up phenomenally, correct? ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [November 11, 2012, 11:13pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/25 "2012-11-11T23:13:53Z")
> [@pkbites](#): > > Easy to do with the full employment the U.S. has, right? Remember, your hypothetical isn’t real. It would require a company that is now providing insurance when there is no penalty to stop once there is a penalty. That’s not something a well-run company is going to do. And if someone does it because of ideological hate for Obamacare, that’s hardly the fault of the program. > [@](#): > > The health insurance I have cost $1600 a month. How does a guy in his 20’s making 40 grand a year pay for that on his own? I went to the Washington Post Obamacare calculator and what I got was this for your 20 something on his own: [http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/#](http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/#) > [@](#): > > Starting in 2014: > You will have the option of buying a health plan through your state’s exchange with federal assistance. Based on your income, your annual premiums for that plan would be no more than $3,800. Your maximum out-of-pocket costs for deductibles and co-payments would be capped at 30 percent of the total cost. > > Insurers can’t discriminate against you for having a pre-existing condition, and can only vary rates within a narrow range. > > If you do not obtain insurance coverage by 2014 you will be assessed a tax penalty. The penalty becomes progressively greater from 2014 through 2016, when it reaches full strength. At that point, assuming your current income remains the same and your household consists of 1 uninsured adult, you would be subject to a penalty of about $744. You are exempt from the penalty if the least expensive plan option in your area exceeds eight percent of your income. So, $316 a month with no more than $1140 a year as deductibles or copays. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [November 11, 2012, 11:36pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/26 "2012-11-11T23:36:06Z")
> [@pkbites](#): > > If this would work why didn’t insurance companies set this up years ago on their own? And what happens when this doesn’t work and the math on it turns out to be a fantasy? Either the system collapses or taxes get jacked up phenomenally, correct? The insurance companies couldn’t set it up on their own- they had no authority to mandate that everyone buy coverage. Plenty of people did not have coverage- some because they absolutely couldn’t afford it and others because they were young, healthy and had better ways to spend the money than paying premiums for health insurance they didn’t expect to use. Of course, some of those people did end up needing medical care and had no way to pay for it. And the hospitals are mandated to provide the care in emergencies. Which means they pass the costs onto self-payers and the insurance companies who in turn pass them on to premium payers. ``` Imagine that you did not have to buy homeowners insurance to cover a house fire- but contractors were required to rebuild any house that burned down, even if the owner couldn't pay. Some people would still buy insurance, because they also wanted the other coverages (theft, liability, tree falls on the house) not just coverage in case of fire. The contractors will have to pass the costs for those with no insurance to those who have insurance. Do you think premiums for those who bought insurance would be higher or lower than if everyone had to buy insurance? ``` ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [November 11, 2012, 11:44pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/27 "2012-11-11T23:44:03Z")
> [@pkbites](#): > > It’s a government plan. It’s beyond Cadillac insurance. More like Rolls Royce. > Before I retired I paid $35 a month for it. Now I pay zip! You got pretty lucky there. The government seems to do pretty good health care. > [@](#): > > If this would work why didn’t insurance companies set this up years ago on their own? And what happens when this doesn’t work and the math on it turns out to be a fantasy? Either the system collapses or taxes get jacked up phenomenally, correct? Insurance companies have set such things up. I am retired, not old enough for Medicare. I pay about $280/month for my health insurance. It is a catastrophic coverage plan which covers annual physicals and immunizations with no copays, I pay for everything else up to $5000 then they pay. A 22 year old male on my plan would pay $130/month according to the plan website. The math seems to be working out for them, even without every 22 year old buying insurance. ---
**Author:** ![pkbites](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pkbites/32/204_2.png) [@pkbites](https://boards.straightdope.com/u/pkbites)\ **Post date:** [November 12, 2012, 12:42am UTC](https://boards.straightdope.com/t/obamacare-questions/640697/28 "2012-11-12T00:42:40Z")
> [@jasg](#): > > You got pretty lucky there. The government seems to do pretty good health care. No, all they are doing is paying for it. When the whole Scott Walker recall thing was at a boil, I was the one who said it wouldn’t hurt government employees and retirees to chip in a bit for their insurance. Folks were outraged by this. ---
**Author:** ![IvoryTowerDenizen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ivorytowerdenizen/32/17937_2.png) [@IvoryTowerDenizen](https://boards.straightdope.com/u/IvoryTowerDenizen)\ **Post date:** [November 12, 2012, 12:51am UTC](https://boards.straightdope.com/t/obamacare-questions/640697/29 "2012-11-12T00:51:48Z")
> [@pkbites](#): > > No, all they are doing is paying for it. When the whole Scott Walker recall thing was at a boil, I was the one who said it wouldn’t hurt government employees and retirees to chip in a bit for their insurance. Folks were outraged by this. Part of the problem is often govt sector folks accept lower salaries in exchange for better benefits. I know this was true for many people I worked with. So if the benefits go down, you’re hit in the pocketbook twice. When I worked for the state I could have made twice in private industry, but I chose the security of good benefits instead (among other reasons). Of course this isn’t true or everyone, but it is a factor. ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [November 12, 2012, 3:29am UTC](https://boards.straightdope.com/t/obamacare-questions/640697/30 "2012-11-12T03:29:34Z")
I’ll post this again: I could get in trouble for naming names, but an internal newsletter at my work indicated some very, very large companies are thinking about dropping coverage for their workers and paying the fine. What’s different now is the exchanges. With the subisides and the larger risk pools people will be able to afford the exchanges that can’t afford to just go out and buy an individual policy now. To answer the original question, even though Sal isn’t now eligable for Medicaid, some states do have programs for low income, single adults, in Minnesota “expanded Medicaid” is called MinnesotaCare, but it does involve modest premiums, so Sal better work a few hours at Wal-Mart or do some busking, and Larry doesn’t get “free” health insurance, he has to pay for it, although I don’t think he’ll get subsidies with that kind of assets he’ll benefit from the larger risk pool. ---
**Author:** ![pkbites](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pkbites/32/204_2.png) [@pkbites](https://boards.straightdope.com/u/pkbites)\ **Post date:** [November 12, 2012, 3:41am UTC](https://boards.straightdope.com/t/obamacare-questions/640697/31 "2012-11-12T03:41:30Z")
> [@Mdcastleman](#): > > To answer the original question, even though Sal isn’t now eligable for Medicaid, some states do have programs for low income, single adults, in Minnesota “expanded Medicaid” is called MinnesotaCare, but it does involve modest premiums, so Sal better work a few hours at Wal-Mart or do some busking, and Larry doesn’t get “free” health insurance, he has to pay for it, although I don’t think he’ll get subsidies with that kind of assets he’ll benefit from the larger risk pool. Wisconsin has this too, it’s called BadgerCare. But I’m talking about Obamacare and the mandate that people buy insurance. What are they going to do about bums who refuse to work and thus have no money or assets? The guy on the freeway ramp with the sign doesn’t really want to work for food. And Larry has no assets. He claims spent the loot on penny slots at the indian casino. ---
**Author:** ![Kimmy\_Gibbler](https://avatars.discourse-cdn.com/v4/letter/k/bbe5ce/32.png) [@Kimmy\_Gibbler](https://boards.straightdope.com/u/Kimmy_Gibbler)\ **Post date:** [November 12, 2012, 4:01am UTC](https://boards.straightdope.com/t/obamacare-questions/640697/32 "2012-11-12T04:01:42Z")
> [@pkbites](#): > > And Larry has no assets. He claims spent the loot on penny slots at the indian casino. He doesn’t even need to lie. He can just put all his winnings in a no-interest checking account (not that anyone would do this). Withdrawals then, are just return of capital, and not subject to income taxation. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [November 12, 2012, 5:09am UTC](https://boards.straightdope.com/t/obamacare-questions/640697/33 "2012-11-12T05:09:12Z")
> [@Mdcastleman](#): > > I’ll post this again: I could get in trouble for naming names, but an internal newsletter at my work indicated some very, very large companies are thinking about dropping coverage for their workers and paying the fine. What’s different now is the exchanges. With the subisides and the larger risk pools people will be able to afford the exchanges that can’t afford to just go out and buy an individual policy now. I’m curious about this but didn’t want to derail this thread, so I started [this](http://boards.straightdope.com/sdmb/showthread.php?t=672028) one in IMHO. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [November 12, 2012, 2:55pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/34 "2012-11-12T14:55:25Z")
> [@Kimmy\_Gibbler](#): > > He doesn’t even need to lie. He can just put all his winnings in a no-interest checking account (not that anyone would do this). Withdrawals then, are just return of capital, and not subject to income taxation. Yes but “total assets” is a means test for welfare-type programs in most jurisdictions, although a link above indicates that it is not the case for Obama’s plan if the state opts in. I suppose you can construct a scenario where someone lives a good life yet is eligible for free health care - but generally those are few and far between. But the first case Sal SLacker, or the naturalist, both mirror the scenario of the street bum - no money, no assets, no work history, no willingness to even try a job. Whether the rules are twisted so the parents must make Sal truly homeless for him to qualify… the devil is in the details of impelmentation. Sal does not qualify for welfare or whatever the state calls it because (a) most states refuse to pay for single, able-bodied people who simply refuse to work, and (b) most states have a total household income rule for welfare. The surgeon’s wife does not qualify for welfare, even if they are simply common law. However, if Sal wandered from house to house sleeping on his friends couches, he’d be in a similar situation but “no fixed address”. If Sal were pathalogically incapable of holding a job, filling out forms, requesting health care, etc. then presumably some social worker would do the work for him the day he eventually ended up in hospital. As for “pay the fine” vs. pay for healtch care premiums - employees are looking for health care. If they don’t offer a plan, then employees will expect enough extra pay to cover the extra household cost. Presumably such an employer would attract mainly healthy, mostly single people with such a competitive package, since they would benefit the most in that arrangement. As his employees married and had children, they would quit and go elsewhere. So his workforce would consist of the young single, inexperienced and those lacking future planning skills. If they pay no more than elsewhere - The argument “hah! Try finding a job in today’s economy” just means that the less capable and less qualified stay behind, the better qualified leave for better choices ASAP. I have seen employers who fall into this category and seem to think they are saving money. What they save in wages they pay out in incompetent action. the only other scenario I see is where the company plan jacks up its premiums so high, it’s cheaper to pay the fine and pay employees also to join the uninsured plan (which presumably, will have some sort of ceiling on prices). Or does “we’ll pay for your personal marketplace plan” get them out of the fine? When say, 50% of the population is on the exchange plans instead of private employer plans, maybe it’s time to switch to a UHC single-supplier government plan… ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 13, 2012, 3:22pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/35 "2012-11-13T15:22:26Z")
> [@Mdcastleman](#): > > I’ll post this again: I could get in trouble for naming names, but an internal newsletter at my work indicated some very, very large companies are thinking about dropping coverage for their workers and paying the fine. What’s different now is the exchanges. With the subisides and the larger risk pools people will be able to afford the exchanges that can’t afford to just go out and buy an individual policy now. You don’t need an internal newsletter to figure this out. It’s pretty much taken as read in the industry that large numbers of employers are going to dump their employees on the exchanges. In fact, large numbers of employers were already going to be dumping their employees on _private_ exchanges, which were The Next Big Thing in employer-healthcare cost control. Now they won’t have to. The thing is, that’s not a bug; it’s a feature. The exchange model offers employees the opportunity to select coverage that works for them, rather than the one (or two) size fits all plans that most employers currently offer, while saving employers money. Win-win. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [November 13, 2012, 3:29pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/36 "2012-11-13T15:29:09Z")
…which in a way is a good thing. The less a health care plan is a form of golden handcuffs, the more open and mobile the job market can become. it also levels the employer playing field, since an employer does not have to choose between a benefit for employees or matching less humanitarian competitors’ cost structures. The question is - If the employer helps pay for an exchange plan, does that get them out of paying the fine? Or is the exchange cost lower, based on the presumption that for a large number of exchange plan participants (except students, self-employed, etc.), there is a corresponding employer fine also going into the pot? ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 13, 2012, 3:40pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/37 "2012-11-13T15:40:48Z")
The employer doesn’t have to contribute a set minimum amount; it has to contribute enough to purchase “minimum essential coverage”. That amount will vary from state to state, of course. It the employer contributes, but less than the amount required to purchase MEC, then it pays the fine anyway. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [November 13, 2012, 4:00pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/38 "2012-11-13T16:00:58Z")
I thought that to prevent people not getting Obamacare until needed (zero reject) that there were fines (oooops according to SCOTUS - taxes) to be paid. What happens to beople that do not pay the fine/ Do they still get Obamacare when they have stage 3 cancer but have to pay the IRS? ---
**Author:** ![Antinor01](https://avatars.discourse-cdn.com/v4/letter/a/ecae2f/32.png) [@Antinor01](https://boards.straightdope.com/u/Antinor01)\ **Post date:** [November 13, 2012, 4:07pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/39 "2012-11-13T16:07:30Z")
> [@pkbites](#): > > Easy to do with the full employment the U.S. has, right? > > The health insurance I have cost $1600 a month. How does a guy in his 20’s making 40 grand a year pay for that on his own? I sell Health insurance. The most expensive plan in my book for a guy in his 20s is $650. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [November 13, 2012, 4:14pm UTC](https://boards.straightdope.com/t/obamacare-questions/640697/40 "2012-11-13T16:14:12Z")
> [@Saint\_Cad](#): > > I thought that to prevent people not getting Obamacare until needed (zero reject) that there were fines (oooops according to SCOTUS - taxes) to be paid. What happens to beople that do not pay the fine/ Do they still get Obamacare when they have stage 3 cancer but have to pay the IRS? I assume that means you either lied on your tax return, owe back taxes, or failed to file. Showing up at the hospital just sets off some sort of alarm for the IRS. Then you get signed up eventually and you will have a back tax bill if/when you are cured. After all, what happens if you end up in hospital while you are being audited or owe back taxes? [Previous page](https://boards.straightdope.com/t/obamacare-questions/640697.md?page=1) [Next page](https://boards.straightdope.com/t/obamacare-questions/640697.md?page=3)