"a 'hardship' exemption for people who cannot afford insurance"

[ProSense]

THE PRESIDENT’S PROPOSAL

Improve Individual Responsibility. All Americans should have affordable health insurance coverage. This helps everyone, both insured and uninsured, by reducing cost shifting, where people with insurance end up covering the inevitable health care costs of the uninsured, and making possible robust health insurance reforms that will curb insurance company abuses and increase the security and stability of health insurance for all Americans. The House and Senate bills require individuals who have affordable options but who choose to remain uninsured to make a payment to offset the cost of care they will inevitably need. The House bill’s payment is a percentage of income. The Senate sets the payment as a flat dollar amount or percentage of income, whichever is higher (although not higher than the lowest premium in the area). Both the House and Senate bill provide a low-income exemption, for those individuals with incomes below the tax filing threshold (House) or below the poverty threshold (Senate).The Senate also includes a “hardship” exemption for people who cannot afford insurance, included in the President’s Proposal. It protects those who would face premiums of more than 8 percent of their income from having to pay any assessment and they can purchase a low-cost catastrophic plan in the exchange if they choose.

The President’s Proposal adopts the Senate approach but lowers the flat dollar assessments, and raises the percent of income assessment that individuals pay if they choose not to become insured. Specifically, it lowers the flat dollar amounts from $495 to $325 in 2015 and $750 to $695 in 2016. Subsequent years are indexed to $695 rather than $750, so the flat dollar amounts in later years are lower than the Senate bill as well. The President’s Proposal raises the percent of income that is an alternative payment amount from 0.5 to 1.0% in 2014, 1.0 to 2.0% in 2015, and 2.0 to 2.5% for 2016 and subsequent years – the same percent of income as in the House bill, which makes the assessment more progressive. For ease of administration, the President’s Proposal changes the payment exemption from the Senate policy (individuals with income below the poverty threshold) to individuals with income below the tax filing threshold (the House policy). In other words, a married couple with income below $18,700 will not have to pay the assessment. The President’s Proposal also adopts the Senate’s “hardship” exemption.

[babylonsister]

1. Bookmarked and Rec'd for more eyes so the complaints might lessen. Not!

:D

[berni_mccoy]

2. Thanks Prosense! I'm so damn tired of people posting "This Bill Will Bankrupt Me!!1!111"

[Lorien]

16. It will; you pay for the insurance, the insurance pays for jack shit

if you've ever paid for your own insurance out of pocket you would know that.

[cali]

37. actually, I have subsidized insurance that I pay $69 a month for

it covers just about everything. Now I'm not saying that all states will run programs as well as Vermont; it will vary from state to state.

[Windy]

3. KR ... there are a lot of people here that are spouting inaccurate info. Thanks! nt

[Cleobulus]

4. "low cost catastrophic plan", so basically a plan to pay for hospitalizations, and nothing else?

Wow, how useless!

[ProSense]

8. That's your choice. The exchange will offer more choices than any employer's plan,

including a non-profit plan. The plans on the exchange are capped.

Bottom line: the plan has assistance built in for those who cannot afford ensurance.

How does the system help you now?

[Cleobulus]

13. Correction, it offers assistance for premiums only, not for anything else...

I won't even qualify to be on the exchange.

[ProSense]

14. The exchange is open to everyone. n/t

[Cleobulus]

18. My employer offers insurance, so no, I'm not able to go on the exchange. n/t

[ProSense]

20. The exchange is offered through employers.

What the hell are you talking about?

[Cleobulus]

23. I thought you were talking about the individual exchanges...

and besides that we aren't sure what will or will not be available until the exchanges actually are opened up.

[Hello_Kitty]

32. No it is NOT. eom

[ProSense]

39. This is not the public option, it's an exchange

State-based exchanges. States would have to pass a law establishing the exchange and would be responsible for running it. If a state fails to establish an exchange by January 2014, the federal government could build it.

link

(ii) LARGE EMPLOYERS ELIGIBLE.—If a State under clause (i) allows issuers to offer qualified health plans in the large group market through an Exchange, the term ‘‘qualified employer’’ shall include a large employer that elects to make all full time employees of such employer eligible for 1 or more qualified health plans offered in the large group market through the Exchange.

PDF

[kirby]

28. That is a false choice...

The exchange might offer more choices, but if you are covered by your employer, you are not eligible to use the exchange. There is also no method to compel each state to create an exchange and the insurance companies (in the Senate bill) do not have to participate. The exchanges do not come online until 2014. If a state does not meet the deadline, nothing significant happens. The Sec of HHS can at some point create an exchange if it is willing to make the finding that a state if not making an effort.

[ProSense]

30. No, it's not. The plan allows people

to opt out of employer coverage:

More Health Insurance Choices

• Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice.
  
  
• Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

PDF

[Hello_Kitty]

35. Oh come on! That's only if the employer provided insurance exceeds the premium limit. eom

[kirby]

38. That is very limited...

You employer gets to choose the plan on the exchange that they offer to their employees, not the individual.

The law states that the OPM multi-state plan is a separate risk pool. So while the sound-bite reads like Congress gave us the same plan that Federal Employees have, it will not have the same cost cutting messages.

From page 2093 of the bill:
"(2) SEPARATE RISK POOL.—Enrollees in multi-
State qualified health plans under this section shall
be treated as a separate risk pool apart from enrollees
in the Federal Employees Health Benefit Program
under chapter 89 of title 5, United States Code. "

The vouchers are only for hardship cases, not the vast majority of people. You cannot take the money your employer pays each month and direct it to a plan of your choice.

[Lorien]

24. You'll be damn lucky if they pay out a single claim without legal action

I've had over 16 years of experience with those assh*les; I lost my life savings because they wouldn't cover a damn thing when they were needed. If the bill doesn't force them to pay up it's totally worthless.

[EFerrari]

5. Great. So now insurance companies will collect the premium

for insurance that low income people can't use. Beautiful.

[ProSense]

9. Where the hell does it say that? n/t

[EFerrari]

19. The word "co-pay" is not in the pdf. I wonder why.

What am I missing?

[enlightenment]

41. They've replaced co-pay and deductible with

'cost sharing' when discussing individual coverage. They use all three terms when discussing employer coverage (at least initially, then they go to 'cost sharing' as you work your way through).

You pretty much have to have the IRS Code open beside you while reading the bill, because it references back to it so much. Note the reference to 223(c)(2)(A)(ii) of the IRS Code of 1986. It specifies that the 'dollar amounts in effect' under that section will apply to this part of the bill:

(c) REQUIREMENTS RELATING TO COST-SHARING.—
11 (1) ANNUAL LIMITATION ON COST-SHARING.—
12 (A) 2014.— The cost-sharing incurred under a health plan with respect to self-only coverage or coverage other than self-only coverage for a plan year beginning in 2014 shall not exceed the dollar amounts in effect under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively, for taxable years beginning in 2014.

Here is the relevant section of the IRS code - section 223(c)(2)(A)(ii). We're familiar with it in summary:

(2) High deductible health plan
(A) In general
The term “high deductible health plan” means a health plan—
(i) which has an annual deductible which is not less than—
(I) $1,000 for self-only coverage, and
(II) twice the dollar amount in subclause (I) for family coverage, and
(ii) the sum of the annual deductible and the other annual out-of-pocket expenses required to be paid under the plan (other than for premiums) for covered benefits does not exceed—
(I) $5,000 for self-only coverage, and
(II) twice the dollar amount in subclause (I) for family coverage.

Translation:
If you buy through the exchange, even heavily subsidized, you will still be responsible for the first $5000 of any medical care you receive - the first $10000 if you have family coverage.

Still, if you are already living in abject poverty (in 2009, that was annual gross income of less than $15000 for a single person), you catch a bit of a break on the premium . . .

SPECIAL RULE FOR TAXPAYERS UNDER 133 PERCENT OF POVERTY LINE.
—If a taxpayer’s household income for the tax able year is in excess of 100 percent, but not more than 133 percent, of the poverty line for a family of the size involved, the taxpayer’s applicable percentage shall be 2 percent.

That's nice, in terms of the premium - but as so many have pointed out, it has nothing to do with the 'cost sharing' aspect. Yes, a poor person may well be able to afford the PREMIUM - but can they afford that $5000 'cost sharing'? Probably not - so even their tiny 2% contribution to the insurance company (with the remainder subsidized by the government with . . . umm . . . where does the government get its money again? From the taxpayers?) is nothing more than a contribution.

Now, if they happen to suffer a massive coronary event while hurrying to their minimum wage job, (an event caused by the uncontrolled high blood pressure that was untreated because they couldn't pony up the money for the doctor's bill, lab tests, and prescription) they'll have coverage and all the people who currently bitch about their rates going up because of those damned uninsureds will be able to breathe easy, because the gigantic hospital bill (which will not be regulated, of course) will be covered!! Woohoo!!



edited for grammar, more or less

[EFerrari]

42. Thank you, enlightenment. I appreciate the info you posted. n/t

[tularetom]

6. This is the kind of thing the liberal media never told us about

And it's exactly what people struggling to make their godawful premium payments need to know.

But, god, what an accounting nightmare this is gonna create. Is the government going to share everyone's 1040's with the insurance companies.

[polpilot]

17. Don't worry about the details. The insurance companies will make it all good!!

[slipslidingaway]

7. A hardship exemption means no access to health care. n/t

[ProSense]

11. No it doesn't, a person whose employer's plan is more than 8 percent of their income

can get a voucher, and will have a choice on the exchange:

More Health Insurance Choices

• Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice.
  
  
• Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

PDF

[Cleobulus]

15. Whose employer's premium is more than 8 percent of income, not the plan itself. n/t

[Xipe Totec]

10. This could be a back-door way to implement PO or Single Payer

What if we were to fine people who chose not to purchase private insurance an amount equal to the cost of Medicare?

And what if we were to provide people who do not have health insurance, benefits equal to Medicare?

And then, what if we were to retain the hardship exemption?

Wouldn't that be equivalent to implementing a Public Option?

Those who chose to pay into a private health insurance plan could continue to do so.

The rest of us could just pay the "fine" and be covered by Medicare.

Just a thought.

[Lorien]

12. And who is going to force the fuckers to PAY CLAIMS for those who pony up for their

shitty products? I've paid over 78k over the years for my own "insurance"; they've paid exactly $200.00 in claims while I've covered over 40k from my own pockets for medical expenses. DOES THAT SOUND "REASONABLE" TO ANYONE???

[griffi94]

21. it sounds perfectly reasonable

if you happen to be an insurance company.

[Name removed]

27. Deleted message

Message removed by moderator. Click here to review the message board rules.

[ProSense]

34. It's OK to thrive on distortions and mischaracterizations, but

why the hell are some people afraid of facts?

[girl gone mad]

22. I duobt many people are going to bother with the fines anyhow.

You can't get blood from a turnip. In case the bill boosters haven't noticed, we're in the midst of ongoing near record unemployment, a housing market collapse and brewing fiscal war with China. People just don't have the money to pay for this bullshit, and if they have to choose between getting the car fixed and putting money into little Janie's college fund, or lining some fat cat insurance exec's pockets, sorry but family and personal obligations will come first.

[Oregone]

25. When I lived in the states, I could have afforded insurance

I just wouldn't of had a cent left over at the end of the day to improve my condition. Another hit against social mobility.

Im glad I saved my dough and immigrated to Canada

[coti]

26. I calculated out how much my taxes are going to go up after the penalty's phased in, and it's only

$420 of money I don't have for the privilege of NOT having insurance I can use when I need to see the doctor!! THANKS OBAMA!! THANKS DLC!!

I'm probably going to take the penalty, because I'm sure that even a "catastrophic" plan (the one designed not to be made use of, with absurd deductibles and copays) would cost me well over $1,000 per year of money I don't have, even after the subsidies. So, when it comes to paying money for nothing (which I do all the time- I've gotten quite good at it, actually), I'd rather pay less money for it! That's just the shrewd businessman I am.

No, really, guys, I know that "I'm better off" with this and I really appreciate being forced into this mess of a healthcare system that I want absolutely nothing to do with. Really.

[ProSense]

29. Which category

are you in:










Go here and play around with individual premiums.




more

[Lydia Leftcoast]

33. Every explanation I've seen tells me that my premiums will go UP

with this bill. I should probably drop my insurance now and save up the money I would have spent on premiums to pay for the time between when the mandate kicks in and Medicare starts. In six years and thousands and thousands of dollars worth of premiums, I have received about five hundred dollars worth of benefit in the form of slightly lower final bills to doctors.

[griffi94]

36. i think the fines will cheaper for a lot of people

i wonder where the tipping point on that will be. you know at what point are more people paying the fines than buying insurance. it seems like that has the potential to blow this whole thing out of the water.
people who already have insurance thru their employer wont have any changes to their insurance. so what if a majority of the already uninsured decide to pay the lesser amount of the fines.
won't that force the insurance companies to double up on the premiums of people who already pay for insurance, or will the govt just write a check for the shortfall.

[subterranean]

31. OMG. The bill just gets more complicated every day, doesn't it?

Seriously, can anyone make sense of that last paragraph?

[SoCalDem]

40. "...people who cannot afford insurance...".. the devil's in the details

who decides what's "affordable"..

there are a LOT of people who "should" be on assistance, but who somehow always seem to make a few bucks too much..

It's going to be very interesting, indeed..

Somehow, I see some cell phone companies & cable companies getting a little miffed about this..

If someone claims "need", and has either of these luxuries, I can see some trouble ahead..

will there be an "allowance" for how much someone can spend on food?
what if their saved grocery receipts show a beer purchase.,.or a magazine purchase..or HORRORS!! cigarettes?

I can see this getting very interesting when people are asked to prove need..

pass the popcorn, please :rofl: