Obamacare requires a Time Machine!

[VoiceofReason]

It's coming.

[sjfcontrol]

It's coming.

A little context might be helpful...

[cb1000rider]

It's been alluded to before on this forum.. Some event that brakes the camels back and revolution ensues. (at least that's what I assume he's talking about)

I got mine. Our monthly premium went "down" from $1,274 to $1,494, and our monthly wealth-redistribution subsidy went "up" from $789 to $702. So our monthly out of pocket for insurance for 2015 goes "down" from $485 to $792 - an out of pocket increase of 63%, right at a time when we are beginning to contemplate retirement. To put it in annual terms, our annual out of pocket insurance cost goes up from $5,820 to $9,504.......for a senior married couple. In other words, they are doing their level best to bankrupt us..

I'm trying to follow the math:
2014:
premium $1274/mo
subsidy -$789/mo
Actual Cost: $485/mo for 2104

2015:
premium $1494/mo (17% increase)
subsidy -$702/mo (12% decrease)
Actual Cost: $792/mo for 2015 (63% increase)

That's a pretty big monthly jump.
Questions:
1) Did your income change or estimated income change for 2015? From what I can find, the subsidy amount stayed the same between 2014 and 2015. I assume the difference is due to projected income.
2) Did your coverage change or stay the same?
3) Without Obamacare, you wouldn't have a subsidy. Were you on a high deductible plan with lower coverage that cost less pre-Obamacare?

Clearly part of the Obamacare plan is to force more insurance on people who wouldn't otherwise buy it... Definite move towards a different system.

Apparently the multi-decade trend is an increase of about 5.2% per year in Texas. That rate out-grows inflation and I'm sure it outgrows most people's income and savings rates. IE - we were going bankrupt before, just a little more slowly than you got hit this year.

Here are my numbers, note I'm part of a shared risk pool, but that pool probably has an average age of about 35 and is mostly male, so I assume our rates are relatively lower than average Coverage is for 3 people.
2014:
premium $648
Subsidy $0
Actual cost $648


Regardless, pre-Obamacare or post-Obamacare, I don't see how anyone short of milt-millionares can afford to retire these days.. If you had a pension that provided healthcare, that's a huge win.. but those are getting really hard to find, assuming the company can even stay solvent.

I understand how Democrats can be blamed for Obamacare. I get that. I don't understand how the entire heath-system crisis can be blamed on the Democrats - that doesn't wash with me at all.

I was recently involved in some litigation. Part of that litigation, factually speaking, was deposition of a surgeon.
That surgeon repaired degenerative spinal damage as part of an out-patient procedure (no hospitals, in out in hours). Probably the kind of repairs that I'll need one day. Cool stuff. They had it down to a process and they were efficient at it. The cost of a 2-hour procedure in their facility was $80,000. Recovery was non-hospital. That particular doctor did between 700 and 800 of these procedures a year. He's quite an income workhorse, meaning he produced between $56M and $64M per year on his own... Personally, I think THAT is a much larger part of what is wrong with American medicine. And I blame that sort of thing on the influence that can be bought on both sides of the of the political party system.

Overturn Obamacare. Go back to low-coverage, high deductible plans. I've got no objection to that. We've still got a system that is going to implode and you can't blame that on the Democrats by themselves.

-CB (BTW, who isn't a Democrat)

[sjfcontrol]

My subsidy went down for next year. Same plan, same income, same deductible.

[sjfcontrol]

Oops, my bad. My subsidy DID go up.

Subsidy up: 11.2%
Plan up: 15.98%

Net Increase: 19.7%

[The Annoyed Man]

It's been alluded to before on this forum.. Some event that brakes the camels back and revolution ensues. (at least that's what I assume he's talking about)

I got mine. Our monthly premium went "down" from $1,274 to $1,494, and our monthly wealth-redistribution subsidy went "up" from $789 to $702. So our monthly out of pocket for insurance for 2015 goes "down" from $485 to $792 - an out of pocket increase of 63%, right at a time when we are beginning to contemplate retirement. To put it in annual terms, our annual out of pocket insurance cost goes up from $5,820 to $9,504.......for a senior married couple. In other words, they are doing their level best to bankrupt us..

I'm trying to follow the math:
2014:
premium $1274/mo
subsidy -$789/mo
Actual Cost: $485/mo for 2104

2015:
premium $1494/mo (17% increase)
subsidy -$702/mo (12% decrease)
Actual Cost: $792/mo for 2015 (63% increase)

That's a pretty big monthly jump.
Questions:
1) Did your income change or estimated income change for 2015? From what I can find, the subsidy amount stayed the same between 2014 and 2015. I assume the difference is due to projected income.
2) Did your coverage change or stay the same?
3) Without Obamacare, you wouldn't have a subsidy. Were you on a high deductible plan with lower coverage that cost less pre-Obamacare?

Clearly part of the Obamacare plan is to force more insurance on people who wouldn't otherwise buy it... Definite move towards a different system.

Apparently the multi-decade trend is an increase of about 5.2% per year in Texas. That rate out-grows inflation and I'm sure it outgrows most people's income and savings rates. IE - we were going bankrupt before, just a little more slowly than you got hit this year.

Here are my numbers, note I'm part of a shared risk pool, but that pool probably has an average age of about 35 and is mostly male, so I assume our rates are relatively lower than average Coverage is for 3 people.
2014:
premium $648
Subsidy $0
Actual cost $648


Regardless, pre-Obamacare or post-Obamacare, I don't see how anyone short of milt-millionares can afford to retire these days.. If you had a pension that provided healthcare, that's a huge win.. but those are getting really hard to find, assuming the company can even stay solvent.

I understand how Democrats can be blamed for Obamacare. I get that. I don't understand how the entire heath-system crisis can be blamed on the Democrats - that doesn't wash with me at all.

I was recently involved in some litigation. Part of that litigation, factually speaking, was deposition of a surgeon.
That surgeon repaired degenerative spinal damage as part of an out-patient procedure (no hospitals, in out in hours). Probably the kind of repairs that I'll need one day. Cool stuff. They had it down to a process and they were efficient at it. The cost of a 2-hour procedure in their facility was $80,000. Recovery was non-hospital. That particular doctor did between 700 and 800 of these procedures a year. He's quite an income workhorse, meaning he produced between $56M and $64M per year on his own... Personally, I think THAT is a much larger part of what is wrong with American medicine. And I blame that sort of thing on the influence that can be bought on both sides of the of the political party system.

Overturn Obamacare. Go back to low-coverage, high deductible plans. I've got no objection to that. We've still got a system that is going to implode and you can't blame that on the Democrats by themselves.

-CB (BTW, who isn't a Democrat)

I used this calculator for my subsidy: http://subsidycalculator.com/. Like others, I am self employed, so I wouldn't t know my 2014 income until after 1/1/15. My subsidy was calculated last year by an ACA Navigator, and she tried to base it on my projected earnings for that month, March 2014 (the month I enrolled), even though I pointed out to her that my earnings might be zero in April, and twice March's earnings in May. There is simply no way to project. She finally accepted my 2012 AGI as a starting point, which is within $1,000 or so of my 2013 AGI.

The law is set up to make it fairly easy for salaried and hourly employees to calculate their subsidy, but it is absolutely absurd for someone self employed with an irregular income stream. Does that encourage or discourage people from starting new businesses? The answer is pretty obvious.

And as you must know from having looked at tax tables, small bumps in income can have large tax consequences. The $87 difference in subsidy for me turns into a $1,044 hit.....which more than eats up the $1,000 improvement in income from 2012 to 2013. So it may be a small amount less, but it is quantifiable that the ACA will leave me worse off this year than last. And for what? Am I getting better insurance than before? No. Here is a fact....... Democrats were warned repeatedly that making health insurance too expensive for the young would result in the young either opting out, or buying the bare minimum, which would in turn lead to a reduced pool for amortizing the cost of insuring the elderly. Did they listen? NO! They NEVER listen. Why, because they are so busy patting one another's backs for their brilliance that they don't have time to do something SO fundamental as doing the math.

They are, in fact, intellectually inferior people; and they are destroying the nation.

So..... Yeah, all democrats can go hang themselves for all I care.

Edited to add: I have NO problem going back to a low cost high deductible plan whatsoever. I'm old enough to remember how it was before most people had ANY insurance. And by the way, the neurosurgeon who did my back surgery back in 2004 told me at the time that between his fees, the anesthesiologist, and the hospital, my fees would have been in the $150,000 range back then. My deductible at the time was $2,500, but I could have handled more if I had to.

[sjfcontrol]

The other problem is determining your income if you're retired. Basically, it depends on what the stock market does. I still don't know my income for THIS year, much less next year. If the government knows what the market is going to do next year, I'd surely like for them to clue ME in.

[The Annoyed Man]

The other problem is determining your income if you're retired. Basically, it depends on what the stock market does. I still don't know my income for THIS year, much less next year. If the government knows what the market is going to do next year, I'd surely like for them to clue ME in.

In their efforts to make costs predictable, democrats have made them utterly unpredictable. The system was in need of reform before, but it is even worse now. Trust democrats to screw it all up. Why? Because they don't know math. [whining]It's too hard.[/whining]

[cb1000rider]

I used this calculator for my subsidy: http://subsidycalculator.com/. Like others, I am self employed, so I wouldn't t know my 2014 income until after 1/1/15. My subsidy was calculated last year by an ACA Navigator, and she tried to base it on my projected earnings for that month, March 2014 (the month I enrolled), even though I pointed out to her that my earnings might be zero in April, and twice March's earnings in May. There is simply no way to project. She finally accepted my 2012 AGI as a starting point, which is within $1,000 or so of my 2013 AGI.

Clarify for me - as I'm not self-employed... What are you allowed to use as a basis for the subsidy? That is, are you locked to using last years AGI? You seem to indicate that it can be done on a basis of income for the current month. That leads me to believe that it can be gamed for your advantage.

If your estimated income was lower than your actual income, can the government claw-back any subsidy amount? If not, that'd sure encourage under-estimation. What about the other way? If you over-estimate income, does the government adjust the subsidy in arrears?

I don't know if it's absurd to ask for an income estimate of someone that is self employed. We already ask for that as a basis of our tax code. That type of madness isn't new. I know that it's difficult to calculate.

Edited to add: I have NO problem going back to a low cost high deductible plan whatsoever. I'm old enough to remember how it was before most people had ANY insurance. And by the way, the neurosurgeon who did my back surgery back in 2004 told me at the time that between his fees, the anesthesiologist, and the hospital, my fees would have been in the $150,000 range back then. My deductible at the time was $2,500, but I could have handled more if I had to.

Yea, I can certainly see that angle. And I'd call it out as the biggest complaint about Obamacare. But the design is pushing for a more "socialized" medical system. It's a system of the "have's" paying for the "have nots".. And you don't get an opt-out choice to a high deductible plan anymore.

I get the premise. And the concept seems like it could make sense (assuming you're willing to accept the socialist aspect). However, I'm starting to think that it's going to fail not because the concept is flawed, but because the foundation of our medical system is broken. Costs are way too high and even spreading those costs out to everyone isn't going to fix it or make it affordable.

I don't remember when people didn't have medical insurance. All I know is that if I was uninsured and walk into the office of my family doctor, my cash bill is going to be $200. With insurance, the bill is $100 (to insurance) and $25 to me.. That's broken. The few things I need done that aren't covered by insurance are ridiculously expensive.... I wonder how many people without insurance actually pay face value of their ER bill? That's broken.

[LDB415]

What do they consider income? Gross? Net? Bottle deposit refund?
And when are they going to come along and require repayment of all the subsidies?

[The Annoyed Man]

I used this calculator for my subsidy: http://subsidycalculator.com/. Like others, I am self employed, so I wouldn't t know my 2014 income until after 1/1/15. My subsidy was calculated last year by an ACA Navigator, and she tried to base it on my projected earnings for that month, March 2014 (the month I enrolled), even though I pointed out to her that my earnings might be zero in April, and twice March's earnings in May. There is simply no way to project. She finally accepted my 2012 AGI as a starting point, which is within $1,000 or so of my 2013 AGI.

Clarify for me - as I'm not self-employed... What are you allowed to use as a basis for the subsidy? That is, are you locked to using last years AGI? You seem to indicate that it can be done on a basis of income for the current month. That leads me to believe that it can be gamed for your advantage.

If your estimated income was lower than your actual income, can the government claw-back any subsidy amount? If not, that'd sure encourage under-estimation. What about the other way? If you over-estimate income, does the government adjust the subsidy in arrears?

I don't know if it's absurd to ask for an income estimate of someone that is self employed. We already ask for that as a basis of our tax code. That type of madness isn't new. I know that it's difficult to calculate.

Edited to add: I have NO problem going back to a low cost high deductible plan whatsoever. I'm old enough to remember how it was before most people had ANY insurance. And by the way, the neurosurgeon who did my back surgery back in 2004 told me at the time that between his fees, the anesthesiologist, and the hospital, my fees would have been in the $150,000 range back then. My deductible at the time was $2,500, but I could have handled more if I had to.

Yea, I can certainly see that angle. And I'd call it out as the biggest complaint about Obamacare. But the design is pushing for a more "socialized" medical system. It's a system of the "have's" paying for the "have nots".. And you don't get an opt-out choice to a high deductible plan anymore.

I get the premise. And the concept seems like it could make sense (assuming you're willing to accept the socialist aspect). However, I'm starting to think that it's going to fail not because the concept is flawed, but because the foundation of our medical system is broken. Costs are way too high and even spreading those costs out to everyone isn't going to fix it or make it affordable.

I don't remember when people didn't have medical insurance. All I know is that if I was uninsured and walk into the office of my family doctor, my cash bill is going to be $200. With insurance, the bill is $100 (to insurance) and $25 to me.. That's broken. The few things I need done that aren't covered by insurance are ridiculously expensive.... I wonder how many people without insurance actually pay face value of their ER bill? That's broken.

CB, the way my insurance agent explained it to me just yesterday morning is this: If you over-estimatd your subsidy for year X, then when you file your tax return on April 15, Year X+1, you will have to refund the balance due for the preceding 12 months of subsidy, either

1. Adding it to your income tax payment owed and sending in the total, or
2. having it debited from your income tax refund, and receiving the remaining balance.

If, on the other hand, you under-estimated your subsidy for the year X, then when you file on April 15, year X+1, you will be refunded for the 12 months of overpayment for year X, and that refund will either

1. be added to your income tax refund, or
2. subtracted from your unpaid income taxes due.[/list
   
   Since we could not nail down a specific income amount (I do not collect a salary from my business. I get paid, when I get paid, and because it is primarily a consulting business with an irregular flow of business, I might do well one month, and horrible for three months, and then well for two months, and nothing for 6 months..... see what I mean? On the months where I have no contracts, my income is just a few hundred dollars per month in hosting fees, and my operating expenses have to be taken out of that, so in effect, I have no income on those months.
   
   I tried to explain all of this to the navigator in March 2013 when I enrolled in a BCBS 4-state PPO plan (silver level). She tried to pin me down on what I expected to earn that March. My answer was, well, IF I get paid for these 2 projects before the end of the month (it was about 3/10 at the time), then my income will be approximately $X.......but I can't say with any degree of certainty if I will get paid for these projects before the month is over. Heck, I might not be able to finish the projects before the month is over, due to customer delays over which I have no control. It's been a while now, but if I recall correctly, the figure we finally settled on was my 2012 gross income, less some retirement account disbursements, and divided by 12. My 2013 tax return seems to indicate that I was very close, if not spot on, using that method.
   
   But the problem is, and I am going to call my congressman about this, is that the self-employed with irregular income streams are practically barred from being able to use the system which they are required by law to use.
   
   If you are self-employed, but you draw a regular salary, you won't have the difficulty I had.

[cb1000rider]

This is essentially what I read which had me confused:
"A provision buried in the new law when it was passed in 2010 provides that incorrect subsidies that are received due to understated income, that are identified by future tax returns, can only be recovered by withholding from future tax refunds. No tax refund= no subsidy repayment!"

Basically that no means exists beyond tax refunds to recover those amounts. I find that hard to believe, as the IRS is really good at getting their money.

But the problem is, and I am going to call my congressman about this, is that the self-employed with irregular income streams are practically barred from being able to use the system which they are required by law to use. If you are self-employed, but you draw a regular salary, you won't have the difficulty I had.

I hear ya. Can you explain how this differs from the estimated tax payments that you make to the IRS? Can you do this month-by-month based on actual income?

Apparently there is no "required" method for determining what subsidy you qualify for? IE - they have to take you at your word. If you are subsidized too much, they pull it out of your tax return. Too little and they'll cover it at the end of the year... That sounds remarkably like our tax system - trying to understand the differences.

[Vol Texan]

I get the premise. And the concept seems like it could make sense (assuming you're willing to accept the socialist aspect). However, I'm starting to think that it's going to fail not because the concept is flawed, but because the foundation of our medical system is broken. Costs are way too high and even spreading those costs out to everyone isn't going to fix it or make it affordable.

Sure, this has been an enjoyable read, but that's where you lost my interest. I'm NOT willing to accept any socialist aspects.

Like TAM, I'm through with anyone who tries to convince me of the benefits of this travesty of a law. It's like trying to convince me that getting shot in the heart (and dying fast) is better than getting shot in the arm (and bleeding to death more slowly), because the pain is over quicker.

[The Annoyed Man]

CB, because of how I do business, I file yearly like everyone else, except that for the past 5 years or so, I have filed an extension in April, and wrap it up during the first week of October. The reason is that I am a one man production shop, and during the down times, I'm a one man sales shop, and ALL the time I'm a one man support shop. I'm also the bookkeeper, doorman, phone operator, and general factotum.

My wife is the Director of First Impressions, but that just means that she talks real sweet to the clients when they come by our home office. I do everything else except the tax prep that my CPA does.

It could be better organized if I had some help, but I can't afford to hire anyone, and my wife's office skills are pretty limited......so that's how we roll.

[G26ster]

I've got one for all you medical insurance experts. Say one has insurance but is limited to Doctors and hospitals in one's network. After coming down with a major disease, you find that few if any doctors or hospitals in your network are anywhere close to the best care available. So, you contact a major cancer center, who's staff is well qualified in your particular disease, but they don't take your insurance, and of course they're not in your network. So you tell them you wish to pay for a medical second opinion "out of pocket" They come back and tell you that the LAW (don't know if it's State or Federal) does not allow them to see patients who have insurance but wish to pay out of pocket! Anyone ever heard of this, and if so I'd appreciate an explanation.