The regulations call for the average family only spending 8% of their income on taxes, however, the IRS now calculates that a family earning $120,000 would pay double that amount. So much for fairness! It is only fair if you are poor!
We went a little further and found the IRS document (http://www.irs.gov/PUP/newsroom/REG-148500-12%20FR.pdf) which delineates the following article. If you are really into self abuse, this will make you very happy.
Obamacare from now we will change the name to ObamaCrapCare as that will be the care that we receive!
Conservative Tom
We went a little further and found the IRS document (http://www.irs.gov/PUP/newsroom/REG-148500-12%20FR.pdf) which delineates the following article. If you are really into self abuse, this will make you very happy.
Obamacare from now we will change the name to ObamaCrapCare as that will be the care that we receive!
Conservative Tom
SURPRISE! IRS CALCULATES CHEAPEST ‘OBAMACARE’ PLAN WILL AVERAGE $20,000 PER FAMILY
When the Obama White House and Congress passed The Patient Protection and Affordable Care Act (i.e. “Obamacare”), we clearly recall being told that the bill would save Americans money.
Yet, as CNSNews.com reports, the Internal Revenue Service (IRS) in a regulation issued Wednesday “assumed that under Obamacare the cheapest health insurance plan available in 2016 for a family will cost $20,000 for the year.”
Wait, what?
Yes, while explaining the penalty for not purchasing government insurance, the IRS calculates that the average annual cost for a family will be at about $20,000.
“The IRS’s assumption that the cheapest plan for a family will cost $20,000 per year is found in examples the IRS gives to help people understand how to calculate the penalty they will need to pay the government if they do not buy a mandated health plan,” CNSNews.com reports.
“The examples point to families of four and families of five, both of which the IRS expects in its assumptions to pay a minimum of $20,000 per year for a bronze plan,” the report adds.
Wait a minute. What is the exact language of the IRS regulation?
“The annual national average bronze plan premium for a family of 5 (2 adults, 3 children) is $20,000,” the regulation states.
Oh.
“Bronze will be the lowest tier health-insurance plan available under Obamacare — after Silver, Gold, and Platinum,” CNS explains. “Under the law, the penalty for not buying health insurance is supposed to be capped at either the annual average Bronze premium, 2.5 percent of taxable income, or $2,085.00 per family in 2016.”
In the new rules published Wednesday, the IRS also made law the regulations regarding the fines and penalties incurred if someone chooses not to buy the insurance. And in an attempt to explain these laws, the agency draws up a few examples.
“[T]he IRS assumes that families of five who are uninsured would need to pay an average of $20,000 per year to purchase a Bronze plan in 2016,” CNS notes.
“Using the conditions laid out in the regulations, the IRS calculates that a family earning $120,000 per year that did not buy insurance would need to pay a ‘penalty’ (a word the IRS still uses despite the Supreme Court ruling that it is in fact a ‘tax’) of $2,400 in 2016,” the report adds.
And just in case you were wondering how convoluted and contrived these new regulations look like, here’s the exact language from the IRS:
Example 3. Family without minimum essential coverage.“(i) In 2016, Taxpayers H and J are married and file a joint return. H and J have three children: K, age 21, L, age 15, and M, age 10. No member of the family has minimum essential coverage for any month in 2016. H and J’s household income is $120,000. H and J’s applicable filing threshold is $24,000. The annual national average bronze plan premium for a family of 5 (2 adults, 3 children) is $20,000.“(ii) For each month in 2016, under paragraphs (b)(2)(ii) and (b)(2)(iii) of this section, the applicable dollar amount is $2,780 (($695 x 3 adults) + (($695/2) x 2 children)). Under paragraph (b)(2)(i) of this section, the flat dollar amount is $2,085 (the lesser of $2,780 and $2,085 ($695 x 3)). Under paragraph (b)(3) of this section, the excess income amount is $2,400 (($120,000 – $24,000) x 0.025). Therefore, under paragraph (b)(1) of this section, the monthly penalty amount is $200 (the greater of $173.75 ($2,085/12) or $200 ($2,400/12)).“(iii) The sum of the monthly penalty amounts is $2,400 ($200 x 12). The sum of the monthly national average bronze plan premiums is $20,000 ($20,000/12 x 12). Therefore, under paragraph (a) of this section, the shared responsibility payment imposed on H and J for 2016 is $2,400 (the lesser of $2,400 or $20,000)
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If you look at what health insurance for a family of five averages TODAY (around $16,000) and figure that the health insurance companies will continue to jack up the premiums every year as they have in past (however, now mostly staying under the 10% annual rate increase beyond which, under ACA, they must show cause why they had to go over 10%), the assumption that it might get to $20,000 by 2016 is reasonable. This hasn't got a damn thing to do with Obamacare! The private insurance companies, not the government, sets the premiums and raises them well above inflation rate every year. Personally, they jacked up my premium 53% this year on my supplemental even though I had no major medical problems. The "10% rule" will slow these suckers down some, but it won't solve the problem.
ReplyDeleteThe good news is that Obamacare will help many of the families pay for these high premiums so that they can afford to remain insured. That is how you get the better quality health measures and lower per capita costs like other countries who have universal health care instead of 40 million uninsured citizens in the richest country in the world.
--David
Your numbers are way off. First of all the Bronze plan is the WORST coverage offered by ObamaCrapCare, it is not top of the line coverage that your price indicates.
ReplyDeletePrices 20+ years go were around $150 per month for great coverage for a family. Then the government got into the middle of coverage, requiring benefits, requiring hospitals and doctors to report certain operations for certain diseases. It also asked insurance companies to get approved, any new benefits or savings. It has not worked.
Intervention by government NEVEEEEER results in better outcomes.
BTW, it will NOT insure, the uninsured. It will leave the 10 million who purposely do not purchase coverage as they are young.
No, my $16,000 number for family plans today is about right. PPACA had it at about $15,200....
ReplyDelete"Overall, CBO estimates that premiums for Bronze plans purchased
individually in 2016 would probably average between $4,500 and $5,000
for single policies and between $12,000 and $12,500 for family policies.
For comparison, the previous analysis of the PPACA as introduced found
that average premiums among all types of plans in 2016 would be about
$5,800 for single policies and about $15,200 for family policies. Average
premiums for Bronze plans would be lower than average premiums for all
plans because the actuarial value of Bronze plans would be 60 percent,
compared with an estimated average actuarial value for all individually
purchased plans of roughly 72 percent. That lower actuarial value would
reduce premiums for Bronze plans directly, because the policy would pay
for a smaller share of enrollees’ costs for covered services, and indirectly,
because enrollees would use slightly fewer or less-expensive services when
faced with the higher cost-sharing requirements included in Bronze plans."
-----------------
The CBO estimates family bronze plan in 2016 at $12,500. Obviously, it is going to vary by number in the family, so it is not hard to imagine a family of 5 paying $20,000 as the IRS example used to illustrate the mathematics, but the $20,000 for 5 is probably closer to the silver plan than the bronze, according to CBO. No matter.
Whatever number you want to use, it is the INSURANCE COMPANIES that establish the premiums, not the government. Sure, left to their own devices, insurance companies might offer a cheaper policy by putting in so many exclusions and limitations that you don't even get basic coverage. They can't make a profit any other way selling family insurance at $150/month. The ACA defines what is necessary in a health insurance policy to assure basic coverage, and then the for-profit insurance companies set the premiums high enough to provide the services PLUS more to cover their advertising, CEO salaries, and high administrative costs of their massive claims departments that work hard every day to deny claims and reduce their payments in order to maximize profits. I know this from personal experience with UnitedHealthCare. That is one of the reasons why we pay more for the same level of health insurance as citizens get in the not-for-profit systems. You, yourself, even admitted that the "public option" would have forced the insurance companies to lower their exorbitant prices. Remember that?
CBO estimates that by 2019 about 32 million more Americans will have health insurance than before Obamacare. Yes, some young people will remain uninsured and burden us with their healthcare when they show up sick in the emergency rooms, but at least now these free-loaders will be required to make a small contribution to their own health care via the tax.
--David
David, you are so out of touch on this. If we add 32 million on health insurance, who is going to treat them. We are losing doctors at high rate. Older doctors are retiring rather than take the cuts mandated by ObamaCrapCare. What hospitals will have the space to treat them? We are not building new hospitals.
DeleteAnd don't tell me it will be done by getting preventative care. We tried that in HMOs and it did not work.
>Intervention by government NEVEEEEER results in better outcomes.
ReplyDeleteThe comparative international data from literally all over the world disproves that statement. Here is another simple two-choice question for you: What is the highest priority of a U.S. for-profit health insurance company?
1. Maximize profits.
2. Public health.
You believe #2 is the correct answer. The rest of us know #1 is the correct answer, and the data prove it. That is why we WANT the basic coverage health insurance policy under Obamacare designed by independent doctors and healthcare experts unaffiliated with health insurance corporations (as it was), rather than by industry executives designing it with an eye toward their own bottom line. They are not "the government". They are expert outside consultants to the government. I trust health insurance companies and their lobbyists to pursue public interest as much as I trust Wall Street to do the same; namely, ZERO!
-- David
David, on this one you are incorrect. #1--ObamaCrapCare was NOT designed by independent doctors and healthcare experts. It was designed by politicians and political supporters of the President.
ReplyDelete#2 if an insurance company does not make money it cannot stay in business and will not be able to provide the coverage for its policyholders. However, the goal of ObamaCrapCare is to run all insurance companies out of business and the provisions contained in the bill will make it so. A company must return premium dollars if their ratios are not right and their claims are lower than expected, however, in a year when their claims exceed expected, they cannot recover the dollars.
Additionally, all children under 19 are going to get free orthodontic care.
NO insurance company input was allowed in this plan, therefore, it is going to be a complete failure. But that is what they wanted!
Here you go, Tom. My $16,000 number is very close to Kaiser's number ($15,745) for 2012, and they are talking about a family of 4, not 5. This is obviously before any Obamacare exchanges have even STARTED! If you add a few thousand to this considering a family of 5 instead of 4, and then factor in the health insurance companies' premium increases from now to 2016, you get very close to the IRS assumption of $20,000. My number is not "way off", it is right in line with CBO, Kaiser, and IRS.
ReplyDelete"MENLO PARK, Calif. – Annual premiums for employer-sponsored family health coverage reached $15,745 this year, up 4 percent from last year, with workers on average paying $4,316 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2012 Employer Health Benefits Survey released today.
This year’s premium increase is moderate by historical standards, but outpaced the growth in workers’ wages (1.7 percent) and general inflation (2.3 percent). Since 2002, premiums have increased 97 percent, three times as fast as wages (33 percent) and inflation (28 percent)."
http://www.kff.org/insurance/ehbs091112nr.cfm
------------
Please note also that premiums are up nearly 100% since 2002, despite that fact that wages are up only 1.7% and general inflation 2.3%. There is no justification of this price-gouging on premiums. The health insurance corporations have oligopolistic pricing power, and they have been exploiting it to the max for decades. One has to be blind to the data not to see this fact.
--David
The numbers I quoted were from an IRS study, not made up. Regarding premiums, most insurance companies do not add additional premiums for any children over 3 so whether it is 3,4,5,23, the price will be the same.
DeleteIf you want to buy the premiums you listed, you should go out and buy them right now. These premiums will not be anywhere near the numbers. I will take any number of bets on that!
Insurance pricing is caused by 1) legal requirements--required medical tests to preclude medical malpractice suits and the high payout to litigants 2) medical fraud--especially in Medicare and Medicaid and 3) patient lack of attention to their bills requiring the insurance company to pay out for duplicate services and benefits. Additionally, the government precludes practitioners from using "off-label" drug uses.
Government intervention has caused these problems. The insurance industry is just trying to make a buck.
>David, on this one you are incorrect. #1--ObamaCrapCare was NOT designed by independent doctors and healthcare experts. It was designed by politicians and political supporters of the President.
ReplyDeleteThe draft legislation was prepared by congressional staff (like any other law), but the ACA was informed by numerous congressional hearings on all aspects of the law in which testimony was received from many physicians, health experts, and (yes) insurance companies also. I watched a lot of it on CSPAN with my own eyes, so don't tell me I am "incorrect."
>#2 if an insurance company does not make money it cannot stay in business and will not be able to provide the coverage for its policyholders. However, the goal of ObamaCrapCare is to run all insurance companies out of business and the provisions contained in the bill will make it so. A company must return premium dollars if their ratios are not right and their claims are lower than expected, however, in a year when their claims exceed expected, they cannot recover the dollars.
Do you have any idea how profitable the health insurance corporations are in this country?
http://www.dailyfinance.com/2010/02/18/health-insurer-profits-jumped-250-in-last-decade/
Since THEY control the premiums, they are not going out of business under ACA, although some of the provisions may cut their profit margins some. That remains to be seen.
--David
David, the "experts that testified were all shills for the Administration. For example AARP testified and they are going to beneficiaries of the program. Unions testified and they are going to beneficiaries. The AMA (American Medical Association) has been a long supporter of ObamaCrap Care however, it only represents a small portion of doctors. All the hacks came out to testify, you could not check out credentials on CSPAN and what they stand for. The proof, however, was in the pudding.
ReplyDeleteAs far as premiums going up, they have to in order to stockpile enough money to withstand the onslaught of ObamaCrapCare. When a company cannot make up their losses in a bad year i.e a year when influenza sends an above normal number of people to the hospital), are limited to any increase they can make (i.e. 10%), your arguments just do not hold water.
David, have you ever tried to read and understand all that is contained in the law? If you had, I doubt you would be making these arguments.
>As far as premiums going up, they have to in order to stockpile enough money to withstand the onslaught of ObamaCrapCare.
ReplyDeleteThis is about the fourth time we have gone around on this. You can track the enormous escalation of health insurance premiums and health insurance corporate profits over the last 20 years, which has clearly been going on LONG before Obamacare. Obamacare has nothing to the do with this! It is simply the result of their oligopolistic pricing power over consumers.
For example, I showed you what a family policy for 4 costs TODAY (before any ACA exchanges have even started) -- about $16,000. I assume you are now ready to admit that fact. Then, assume the insurance companies will continue, as always, to jack up their premiums multiple times the inflation rate as in the past (only slightly constrained by the ACA "10% rule"), and you arrive at the $20,000 premium for a family of 5 assumed by IRS. This has nothing to do with Obamacare.
The premiums are set by the insurance companies, not the government.
The premiums are set by the insurance companies, not the government.
The premiums are set by the insurance companies, not the government.
--David
Fact-checking…
ReplyDeleteDoctors overwhelmingly support the ACA….
http://npalliance.org/blog/2012/11/04/why-physician-groups-support-the-affordable-care-act/
http://www.drsforamerica.org/about/recent-campaigns
http://abcnews.go.com/Health/medical-organizations-respond-aca-ruling/story?id=16673570
I have a dozen more, if needed. Yeah, I know, they are ALL "shills" for the ACA.
--David
If they are all so in favor of ACA, why are thousands of leaving the business u.http://www.memphisdailynews.com/news/2012/aug/8/survey-34-pct-of-physicians-to-leave-practice/ You are smoking funny cigarettes.
Delete56% of all visits are for primary health needs, yet 38% of all doctors are primary care and only 8% of graduates of US medical schools are going into primary care. Where are the 20-80 million new users of health care going to go when doctor numbers are significantly less?
>When a company cannot make up their losses in a bad year i.e a year when influenza sends an above normal number of people to the hospital), are limited to any increase they can make (i.e. 10%), your arguments just do not hold water.
ReplyDeleteWrong. The ACA says that they can jack up the premiums up to 10% annually with "no questions asked." Very generous.
They CAN go over 10% in a "bad year", but they have to show justification to HHS. You say I don't know the law, but I seem to know more about this than you do.
--David
Who says they can raise the premium, they cannot recover losses due to the major illnesses.
ReplyDelete>Who says they can raise the premium, they cannot recover losses due to the major illnesses.
ReplyDeleteThe HHS regulation says they can raise their premiums above 10% but must show justification for the increase. They can no longer drop coverage on you if you become unprofitable to them. They should set their premiums high enough so that their profits from healthy people offsets their losses on the extremely sick. Remember that 5% of the people account for 65% of healthcare costs. That ratio will be improved by getting off the fee-for-services model and paying for value.
The problem with primary care physicians has been going on long before Obamacare. I attended a lecture by physicians a few months ago, and they said most doctors would rather be specialists rather than primary care, simply because they can make more money. The government didn't create that problem and the government can't fix it. The problem predates Obamacare. It has to do with the labor economics of the medical field in this country.
--David
Two points--the HHS premium models have not been set yet, so I don't know where you are getting your information.
ReplyDeletetwo-ObamaCrapcare is not covering people on a fee-for service model. It is a fee for outcome which is entirely different. You go in for a headache and they pay for the headache going away. If you come back in with a stroke, the hospital, doctor get nothing else.
As far as doc crisis, ObamacrapCare could do something about it. How about paying off a medical school bill if someone acts as a primary care physician for X years? What about allowing more primary care physicians to come in from foreign countries?
As far as companies getting back money they spent on care, that will not happen because the real intent is to drive out of business ALL insurance companies and go to a single payer system.
The HHS rate review is already operational, and many attempts by insurance companies to jack up rates more than 10% have been rejected by HHS...
ReplyDeletehttp://www.healthcare.gov/news/reports/rate-review09112012a.html
This was one of their old strategies to get rid of unprofitable customers. They just jack up the rates so high that people cannot afford the premiums. The other strategy was to deny claims on so-called "pre-existing conditions." Another was the life-time cap on how much money you cost the insurance company. These are all contributors to the 40 million uninsured.
You don't understand the difference between paying fee-for-service and paying for value. Remember the formula: Value = Quality/Cost. You look for the most proven-effective diagnostic and treatment protocols that have the lowest costs. That produces better outcomes at lower costs than the fee-for-service model.
--David
David, before you comment, please read what I wrote. I did not say anything about the review of the bogus 80/20 rule which only will drive out business. That is in place.
ReplyDeleteWhat I wrote about was the 4 tier premium models which mandate that the rates cannot vary more than 2% more or 2% less than a "model" premium. Those pricing models HAVE NOT BEEN SET UP AT THIS TIME.
Your points about rate increases are bogus for 75-90% of patients. Rates measured on the 80/20 rule are for individual and small group (under 50 employees) and not the large group plans which are covered by a 85/15 rule.
Rates on individual or small group generally are based on a block of business in a state. It does not go after individuals or groups and raise their premiums! Large groups are rated on their performance alone and are not grouped together with other groups generally.
As far as "pre-existing" conditions, this is also bogus. As I wrote yesterday, my client had a multiple thousand claim and had no problems. I never have had a client have a claim turned down for "pre-existing" unless the client did not tell the truth on the application. If you lie on any insurance application that voids the contract--that is basic contract law.
Lastly, it is you, David, who does not understand the change that is coming with ObamaCrapCare in regard to the change from fee for service to fee for outcome. Which means that if you have an allergic attack one day and are treated and ObamaCrapCare pays, and then two weeks later have another attack, they will NOT pay as this was a second event from a similar cause.
Many people will have to be re-admitted due to a re-occurance of an event at which point ObamaCrapCare will not pay the hospital, doctor, lab, rehab or whatever since that "cause" had already been paid for.
Not good news for the country or the individual person. Additionally, if you want great coverage similar to what you had before, it is going to cost thousands more than what you had paid before.
Quoting from the link I gave you…
ReplyDelete"Savings from Rate Review of Increases above 10 Percent Threshold
To date, based on those filings at or above the 10 percent threshold, approximately 64 percent of determinations have been found to be unreasonable or have been modified or withdrawn (see Figure 1)."
This is what I am talking about, not the premium structure of the 4-tier plans. Get it?
Second, I am aware of the different medical loss ratios (80/20, 80/15). My point there is that Obamacare has already forced the insurance companies to rebate over $1 billion to their customers. Unfortunately, the penalty is not large enough. Like the Wall Street banks, most of them just treat these things as a cost of maximizing net profit.
On pre-existing conditions, the ACA states…
SEC. 2705 [42 U.S.C. 300gg–4]. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
‘‘(1) Health status.
‘‘(2) Medical condition (including both physical and mental illnesses).
‘‘(3) Claims experience.
‘‘(4) Receipt of health care.
‘‘(5) Medical history.
‘‘(6) Genetic information.
‘‘(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
‘‘(8) Disability.
‘‘(9) Any other health status-related factor determined appropriate by the Secretary.
>Which means that if you have an allergic attack one day and are treated and ObamaCrapCare pays, and then two weeks later have another attack, they will NOT pay as this was a second event from a similar cause.
Huh? Show me where this is stated in the ACA.
--David
The ACA prevents an insurance company from preventing someone from getting insurance, however, it does not prevent the insurance company from charging more due to the pre-existing conditions! Read the quote you sent, it does not prevent additional charges.
DeleteCheck out this link on pay for performance/pay for outcomes etc.http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78
This is outcomes! Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.
ReplyDeleteSource: http://www.healthcare.gov/law/timeline/full.html
>The ACA prevents an insurance company from preventing someone from getting insurance, however, it does not prevent the insurance company from charging more due to the pre-existing conditions!
ReplyDeleteAbsolutely. Have I not been telling you for a week that the INSURANCE COMPANIES, not the government, sets the premiums? What the ACA does is stop the insurance companies from excluding nonprofitable (i.e., sick people) from coverage. With insurance, they will get better health care, and, if they are low-income, they get financial assistance to pay the premium.
I read your link. We are obviously at the beginning stages of working out a plan to replace fee-for-service model with Value=Quality/Cost model. The idea is to reward providers who provide evidence-based diagnostics and treatment protocols on a cost-effective basis. It is going to take some time to test and refine the model, but ultimately it is the direction to go in order to improve quality and lower costs for Medicare, which is something you and I both desire. That status-quo ain't working!
--David
Sick people have always been able to get coverage--in Michigan and Colorado. I am not aware of the other markets so I cannot speak intelligently about them. However, in Michigan, Blue Cross was REQUIRED to take anyone regardless of their health conditions. This argument has been one that the Democrats spread far and wide and it seems to be to be inaccurate at least in the two markets I am familiar.
ReplyDeleteAs far as financial assistance, those details are still being worked out. however, people whose income is under $92,000 will financial support. If both spouses earn less than 92k, then they both will get money. Sounds like a really good ponzi scheme!
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
ReplyDelete‘‘(1) Health status....
----------
I never said ALL insurance companies did this prior to Obamacare. The point is that it is now illegal for ANY of them to do it.
--David
Those companies who abused the system before will abuse it again. That is human nature. No law, regulation, or moral code will change that and to think so is folly.
ReplyDeleteThose who are sick could always get coverage and now that has not changed. The cost to the sick will be significantly higher now that the companies can raise the rates on them. That sir is what is called a lose-lose situation.
And if you think that they could not afford it before, now with the higher premiums (even if premium offset) do you really think that they can pay for it now?????
ReplyDelete