I'm still wondering what apparent ACA supporters on this blog are going to pay. There was a squawk from Patrick about the cost calculator at npr.org, then silence.

The loophole is not quite as big as it may appear.
ACA was written by people who are good at screwing people over, getting things passed then doing bait and switch. So now that it has passed, and passed the Supreme Court, with a nominal fee of $95. What stops them from making it a real painful penalty next year say 9,500. Or have new policies not become active till the end of the year or quarter instead of the end of the month.

There is at least one flaw in the "wait to buy insurance until you need it" game plan. While it is true you won't be denied the ability to buy a new insurance policy based on pre-existing conditions, your newly minted policy will NOT have to retroactively cover expenses already incurred. So...if you are newly diagnosed with a condition that will require near or long term treatment you can get a policy that will cover those upcoming expenses BUT if you have already run up expenses...say, prolonged hospitalization following serious trauma from a car crash...and then get a new policy you will be covered for any NEW expenses from that point forward but not the bill you've already run up. You will be on the hook for that.

Speaking as an MD (I know Mike going back to when he was a resident at UAMS)the traps in Obamacare are legion and I think most folks are going to be quite surprised as each layer of the rotting onion is peeled back.

That is what they were doing in Massachusetts. And they were getting away with it. The penalty is going to max at 2.5%. So it might be a good strategy.

"What stops them from making it a real painful penalty next year say 9,500. Or have new policies not become active till the end of the year or quarter instead of the end of the month."

I need to do some research on this since, it has been a long time since I studied tax law in law school, but if I recall correctly, taxes, and tax penalties have to be reasonably proportional as a revenue raising measure. They can't be punitive. So a huge penalty for not having insurance may be unconstitutional.
When John Roberts called the IRS penalty a "tax" he may well have stopped the ACA from raising penalties high enough to actually make it work.

I have also heard that the ACA penalty can only be collected out of refunds due, so a careful planner may be able to insure that the penalty is not collectable by making sure they don't over pay the IRS. (I haven't verified if this is actually true or not). But I do know the law was so sloppily written that it didn't include a method of calculating income to determine eligibility for subsidies.

For those who do choose to take the penalty rather than buy a policy, be aware that the penalty tax is progressive over the next several years and not just a flat $95 for everyone. For 2014, the annual one-time tax penalty will be $95 per adult, or 1% of your total income WHICHEVER IS LARGER, based on your income. For uninsured children in your family, the penalty is $47.50 per child, with a family maximum of $285 for the year.

Because coverage is assessed on a monthly basis or prorated, you will only owe a portion of the total penalty for the months that you are uninsured. The health care reform tax penalty will be imposed on your 2014 tax return filed in 2015.

And the annual penalty will INCREASE each year. For 2015, the annual penalty will increase to $325 per adult and $162.50 per child, with a maximum penalty of $975 per family (or roughly two percent of total income depending on family income). In 2016, the annual penalty will be $695 per adult and $347.50 per child, with a max of $2,085 per family, or about two and a half percent of total income depending on family income, WHICHEVER IS LARGER.

OTOH, the IRS has no mechanism (yet) to assess the penalty other than removing it from any tax refund you are due for the year in question. Structure your taxes so that you are owed no refund and, viola!, no penalty.

The numbers in my post above are from Turbo-Tax and certainly could change depending on whether the law changes or is otherwise modified as things progress.

Also...many insurance carriers currently limit their "open enrollment" period to only a few months each year (Fall months are common). So, assuming that practice continues (and there is currently nothing in Obamacare to prevent it)... you certainly can get a policy when they open their enrollment in October without worrying about any pre-existing conditions alright. But if you have been running up medical expenses since you fell off a ladder or developed breast cancer back in June you are still going to have to pay those expenses yourself (as per my first post above).

Well, I'm giving up, my policy was cancelled and the new one has quintupled my deductible, and nearly doubled my premiums and copay.

Technically given changes to the VA system I think I qualify for "free" healthcare under them.

But I've reached the point where I dont think this behemoth can be whittle down or change course so I'm seriously considering being just one more piece of dead weight in the hopes that it finally collapses under the strain

So now that it has passed, and passed the Supreme Court, with a nominal fee of $95. What stops them from making it a real painful penalty next year say 9,500.

It's actually $95 or 1% of your income, whichever is higher.

But here's the thing: there is no enforcement mechanism. The IRS can not garnish your wages, or place a lien on your property. They could make it $9500, but if they don't amend the law with an enforcement mechanism it really doesn't matter.

And if they do, well, that's inviting rebellion.

"And if they do, well, that's inviting rebellion."

I doubt that, because many don't know there isn't one already, and I fully believe it will be attached to some bill and snuck in. Then won't be noticed until next April 15th when it is directly attached.

On first glance it does seem like a great idea to skip insurance, but as Patrick said, there's the limited enrollment window and the possibility that something might happen that needs immediate care. Heart attack, car accident, sports injury . . . all those those things require immediate treatment & possibly hospitalization or surgery. They might not happen, but if one does then you are totally screwed without the negotiated rates of your in network provider. As I recently found out - in network rated for anesthesiologist: about $400 (including what insurance coughed up). Without: about $1800. (cut down to about $700 after negotiating with the office). And that's just one Dr. Surgery center's bill was $28K to the insurance company. Your best bet is to negotiate upfront with any elective procedure but it still adds up fast. And if you actually have to enter a hospital? you are SCREWED.

"And if you actually have to enter a hospital? you are SCREWED."

If the ACA actually gave you access to a hospital and a doctor with a reasonable co pay, and deductible, you would be correct.

But since so many doctors, and hospitals opted out of the Obamacare exchanges, and you will probably have to come up with 10k or so before they cover even one dime of the cost of a simple broken arm, there is little reason to pay three to five hundred additional dollars a month in premiums for the dubious privilege of being enrolled in Obamacare.

For most people going bare, and putting that money in the bank is a smarter option.
And for those of you panicked about the cost of being injured in a car accident, read your auto insurance policy. It covers hospitalization.

Given the governemnt REQUIRES insurance under threat of taxes, which unpaid can lead to jail, wouldnt a limited enrollment be illegal?

What happens if you get dropped off you parent s plan the week after open enrollment ends?

How can you punish someone for fail to buy something companies are actively refusing to sell?

I've decided to stick with my health insurance that has become (thanks so much, Obama!) too expensive

Amy, I'm in a similar situation to what you've described as yours. My wife and I had Kaiser plans which aren't ACA-compliant, so Kaiser notified us they were switching us to their Bronze-level plan, for about $300/month more than what we were paying (and of course, the deductible and copays are higher).

However, I just found out that if I sign up for the identical Kaiser Bronze plan through the Covered California website, we get a tax credit which effectively reduces the premium by 80%. YMMV due to income, but I suggest you look into that option if you haven't already.

Rex: check out the shell game that you've just involved yourself in. At no time is the actual receipt of treatment or the payment of doctors addressed.

Not sure what you mean by that, Rad. The plan does specify a deductible, a percentage of costs that are paid by the plan after the deductible is met, and a maximum out-of-pocket expense for the year. And it's the exact same plan Kaiser was going to switch me to, so I assume I still get to see the same Kaiser doctors I did before.

If there's something I'm not seeing here, please enlighten me. I think I still have time to change course.

If there's something I'm not seeing here, please enlighten me. I think I still have time to change course. -- Rex Little at December 17, 2013 4:22 PM

I think he's saying check with the providers you have used in the past, or may consider in the future, and make sure they'll accept the Kaiser Bronze-level plan. There are many providers that are refusing to accept the new (generally lower) reimbursement levels.

So you may have insurance, but if you have to travel 60 miles, each way, to find a doctor/hospital that accepts it what good is it?

If that's all it is, no problem. Kaiser has its own network of providers, so I've been restricted to them all along. (The nearest one is, in fact, an hour's drive away.)

If that's all it is, no problem. Kaiser has its own network of providers, so I've been restricted to them all along. (The nearest one is, in fact, an hour's drive away.)
Posted by: Rex Little at December 17, 2013 7:34 PM

Radwaste is correct. Be smart, and call your current doctors, and see if they are accepting the Kaiser plans bought through the exchange.

My understanding is that the reimbursement rates in California for the ACA plans are at the medicaid level, and a Kaiser plan bought through Kaiser may not effectively be the same as one bought through the exchanges. You are in a different pool. And that may make a huge difference.

I don't think you guys understand how Kaiser works. The doctors aren't independent practitioners reimbursed by Kaiser--they work for Kaiser. If you have a Kaiser plan, you see a Kaiser-employed doctor; it's not like (s)he has a choice to accept your insurance or not.

Now, under ACA it's possible that Kaiser is paying its doctors less than before, and some of them may leave Kaiser and start their own practices (or just quit). But I wouldn't be able to see those doctors whether my plan was bought directly from Kaiser or through the exchange.

"I don't think you guys understand how Kaiser works. The doctors aren't independent practitioners reimbursed by Kaiser--they work for Kaiser. If you have a Kaiser plan, you see a Kaiser-employed doctor; it's not like (s)he has a choice to accept your insurance or not."

I understand this perfectly. However what you dont seem to understand, is almost all insurance even the Kaiser plans have provisions for out of network coverage, in case of certain conditions, emergenices, and when you are traveling.

The standard plan you buy through Kaiser probably has those situations covered, but since the Obamacare plans, almost certainly, do not, they should be looked at very carefully to see if they actually are "the same plan".

Do you really want to be rushed to the nearest emergency room after a heart attack, only to be handed a bill for thirty k because the emergency room, and the doctor were not part of the Kaiser network?

I see what you're saying, Isab, but that's a different issue from "call your current doctors, and see if they are accepting the Kaiser plans bought through the exchange." In any case, I just called Kaiser and verified that the plan I signed up for through the exchange is the identical one that Kaiser was going to switch me to anyway (California isn't allowing non-ACA-compliant plans to continue after 2013), and that it does cover emergency visits to non-Kaiser facilities.

As for travel, any place I go in the US is likely to be closer to the nearest Kaiser facility than where I live.