Two basic Obamacare GQs

  1. Please confirm…penalties for not having any insurance kick in on 1/1/14. The penalty is about $100 a month but you don’t pay it until you file your 2014 tax return in 2015. It is only a penalty and you don’t get any health coverage at all for paying it. The penalties go up in subsequent years to something like $350 and $650 per month. Is it per person including kids?
  2. Are some of the insurance cancellations and premium increases at least in part due to requirements that there be additional coverages (procedures and beneficiaries) effective 1/1/14? Assuming so are there even more of those kinds of requirements coming along in subsequent years?

One thing that is true about the penalty is that it can only be taken out of any refund you are due. It is not like a normal tax liability where you can be brought to court by the IRS. If you carefully plan out your deductions/dependants or whatever, you may never end up paying any penalty for not carrying insurance at all. As long as the government never owes you a refund, you’ll never have to pay the penalty.

The cancellations basically exist because insurance companies don’t think that they can keep offering the old grandfathered policies and make a profit anymore, and Obamacare prevents them from keeping grandfathered status if they significantly change, including price. So since they can’t raise premiums on these plans, they have to cancel them and offer other (usually more expensive) plans.

The penalty is annual, not monthly.

It’s also the greater of $95 or 1% of “income over the filing minimum” (I don’t know what the minimum is).

It is per person, but there’s a family limit.

EDIT: Third bullet here:

From reading the link, it appears that one of the exceptions is when the premiums would exceed 8% of your income. I was about to ask, what happens to those individuals in red states where the state governments have refused the expanded medicaid eligibility?

It would be rather cruel to charge people that $95 penalty because they cannot get even medicaid because their state government decided they weren’t worth insuring…

If you opt to pay the penalty you do not get any coverage for that payment.

There is no change tothe law that hospitals must provide emergency care to stabilize a patient without regards to ability to pay. Hospitals are not compensated for such care. The hope with Obamacare is that more of these patient will have insurance and thus the hospital will get something for the care they provide in this way.

I didn’t know that about “grandfathered” plans… that no changes were required as long as no other changes were made. That must have been origin of the “you can keep your plan if you like it” claims made.

The penalty is annual, huh…good to know.


That’s wrong. There are changes that are required to be made in old insurance plans even if no other changes were made. That’s the origin of saying Obama lied.

As I understand it, to qualify as an insurance plan, the plan must meet minimum coverage standards - what is covered, what proportion are co-pays, deductibles etc. Simply calling it health insurance plan does not make it one. Much of the coverage cancellations in the news are poor plans that do not meet the minimum standards. The companies offering those plans have the choice - either bring the plan up to ACA standards (and charge more) or cancel.

IIRC there is also that provision that 85%(?) of premiums must be spent on health care, no egregious profits. It’s possible that some companies are cancelling plans because they would otherwise have to admit they were overcharging and lower premiums.

Considering the political atmosphere, it possible that some companies are using the propaganda value - instead of “you plan will be modified” they say “we’re cancelling your plan and here’s a new one” which is interpreted as “because of ACA we are cancelling your plan”.

Just to be cynical -

I believe the provision(s) by which the individual policies can be cancelled is a bone to the insurance companies (as if they aren’t already getting rich off the ‘2014’/ACA plans) - “here is a group you can screw over as much as you want - just like old times - they aren’t organized, can’t do anything but buy another policy - ream away!”.
In my case:
old, cancelled policy: $500/mo
new, compliant policy: $650/mo.

Result: I become one of the uninsured we are trying to eliminate.

Long story, but I don’t qualify for ACA subsidy, and even the cheapest ACA policy would be $750 or so without subsidy.

What sucks is my pharmacy bill actually made the $500/mo a break-even proposition. Looks like I now either stay in bed or suck (cheap) opiates like candy. Or endure incredible pain.

And some of the current plans that are being cancelled are good, affordable plans that do not meet the minimum requirements for ACA because they do not cover every mandated condition. Such preventative things as birth control are not covered by many current insurance plans. It is not that these are crappy plans, they just do not meet all of the requirements.

And coverage for co-pay or no-pay birth control is one of the things that is making current plans that people have obsolete. You can no longer shop for what you may need and omit coverage that you will never need.

You have until March 31st to enroll before you incur a penalty, according to this:

So then, some of the increase in premiums is also a function of new mandated coverages or covered people.

I wonder if there is any way to break that out on average.

… or if there is any way to anticipate future costs due to future mandates (if any).

If the changes required were minimal - i.e. just add birth control - then the plan could be modified with very minor price increases.

Moer likely, either (a) the plans are seriously deficit in several areas and compliance would make them expensive, or (b) some in the medical insurance industry are calling it a cancel and new policy rather than a repricing, for the propaganda value. As I said earlier, don’t discount the possibility that (b) is influenced by the profit percentage. If the plan is too lucrative for the provider, it runs afoul of the 85% rule? In that case, do you say (a) “sorry, we’ve been overcharging you for years, the price is dropping” or (b) “due to Obamacare we have to cancel your plan”?

Any idea how minimal birth control is …especially now that older children have to be covered?

Any idea how minimal other minimal changes are?

Let’s see - right off the bat, half the population does not need it. Probably half the remainder does not use it. I don’t know if it coves all forms - condoms, diaphragm and gels, etc - or just pills, IUD insertion, and other doctor procedures?

Yes, it seems the law leaves some in the “too poor to pay, but too rich for subsidy” black hole.

There was also the snafu about Medicaid. As the law was written, Medicaid was expected to cover a whole lot of people who couldn’t afford insurance. Note that the subsidy is only available to people with income of 100% to 400% of poverty level. People with income less than 100% of poverty aren’t eligible.

WTF? The poorest, who need the subsidy the most, can’t get it. Not to worry! They will get Medicaid. That was the plan when the law was designed.

Uh, yes, worry. The Supreme Court said states could decide if they want to expand Medicaid, and many are not. But the SCOTUS did NOT say, at the same time, that the poverty rules for the subsidy need to change. So people making less than 100% of poverty level, who were intended to be covered by Medicaid, are now scrod in the states that aren’t expanding Medicaid to cover them.

I read all this in an article just yesterday, but with so much on-line web pages about Obamacare, GFL trying to find that article again. So sorry, no linky.

ETA: Okay, here’s a link.

A bit more (sorry, missed edit window):

It’s not at all the same article I read, but at first glance this one looks much better, more detailed, and more authoritative. This one is by the Kaiser Family Foundation (which is not affiliated with Kaiser Permanente HMO, by the way).

So basically you don’t know or don’t care to participate in the GQ.

For anyone who does …

If a premium increased by 35% is there any info available as to how much was the normal annual increase we’ve been seeing for years (maybe 25%?) and how much was due to Obamacare requirements (maybe 10%) … and then are there future requirements that can be expected to cause future increases? If so, how much (example: 1/3 of the requirements have kicked in so far so expect even bigger increases in the future).

Provide citations. Otherwise you are just making a political swipe.

As far as I can tell, it really isn’t. Or at least, the one example I have of it happening is clearly the fault of the insurance company. They specifically chose a gold-standard policy, when there are lower standards they could also choose. They refuse to offer people the choice between less coverage and similar cost.

This can only happen in an inelastic market. They are counting on the fact that most people will not try the competition to get a lower plan.

They also did not advertize a bit about whatever it is that they are having to now cover that they didn’t before. So I think even they are using it for political purposes. If you just read what they said, it just sounds like they chose to raise costs because ACA let them, blaming Obamacare for their own choices.