susanb
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Post by susanb on Jun 28, 2012 19:49:05 GMT -5
I can see both sides here.....
DH and I talked about this law today. We do see it as a way to get out of the insurance business and may very well cancel our policy next year.
Here is the thing..... Currently, we offer health insurance as a benefit to attract employees. However, because we are a small business, it costs us more to provide people with a group plan than it does for people to purchase individual insurance. Someone approached us this year asking for the cash we pay for their policy. They planned to purchase their own insurance on the private market. We agreed immediately because the insurance has been increasing at 8% per year.
There are two reasons that the insurance we provide is better than the insurance people can buy in the private market in our state:
1. There is only one private policy in our state that covers maternity 2. Pre-exisiting conditions
We are paying an average of $7,200 per year for insurance per employee. If changes in private market plans resulting from this law mean that they can go out and get the same/better coverage for a comparable price, we would gladly pay them the money and cancel our company policy.
Separating employment from insurance is a win for our employees and for us as business owners.
The potential negative is that premiums will likely rise more rapidly than salaries. The person who opted to self insure at our business may be in for a surprise.
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NastyWoman
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Post by NastyWoman on Jun 28, 2012 19:49:50 GMT -5
I don't see it as that different from car insurance. I am required to carry car insurance but as long as I don't hit anyone/thing then there really isn't a penalty if I DON'T carry it, but once I do hit someone then all hell is going to break loose. That may be true in Nebraska, but if you cancel your insurance in CA you'll have a letter in your mailbox before you can say by your leave. I found that out couple of years ago when I sold my car to my son who lives out-of-state, removed it from my insurance and the DMV lost the transfer records. edited to add for the upholding healthcare law. It may be imperfect but it is at least a start in the right direction
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Peace Of Mind
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Post by Peace Of Mind on Jun 28, 2012 19:51:05 GMT -5
This whole argument feels weird. The point of a fine was to motivate employers to provide insurance to their employees. How did it get turned around to companies dropping insurance instead? For every action there is a reaction. Let's hope it will be a positive one.
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susanb
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Post by susanb on Jun 28, 2012 19:55:14 GMT -5
This whole argument feels weird. The point of a fine was to motivate employers to provide insurance to their employees. How did it get turned around to companies dropping insurance instead? For every action there is a reaction. Let's hope it will be a positive one. Currently, companies are able to offer superior insurance to what most individuals can buy through private plans. If individuals are able to purchase private plans that are just as good as what companies offer, it makes sense for companies to pay individuals more and have the individuals purchase their own insurance. Sort of like how your company pays you money and you select your own food, house, etc...
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fwjone819
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Post by fwjone819 on Jun 28, 2012 19:58:24 GMT -5
I have always lived in rural areas with mostly smaller businesses. In the past, I have heard employers complain about cost of offering health care to their employees and how much they could save if they didn't offer it. BUT the offset of that was that most employees would not have insurance if not offered in the job place and that would potentially lead to a less stable, more sick prone workplace so they stated it was better to pay for insurance. With the change in health care coverage, it would seem that it is no longer a valid argument. People will supposedly have access to health care "affordable" and those that don't will supposedly be fined/taxed. So a lot of little businesses may be weighing the outcome and deciding that while in the past, it was beneficial to them, now it would be better to take the fine and have more income. ... Just a thought. Also, having worked in health care, I have witnessed public use and abuse of insurance. Many people who have access to medicaid, private insurance, and medicare still don't access the health care system in positive ways. They don't go to their family doctor because they don't want to wait several days for an appointment, don't want to sit in the doctor's office and wait for their appointment and/or don't want to pay the co-pay required by said insurance (or they owe their family physician so much they can't be seen until they pay their bill). These folks trot right into the ED with their 3 week sniffles and demand to be seen "immediately" for their illness. Then they complain about how all 4 doctors they have seen have all ordered the same tests repeatedly or that all 4 gave a different diagnosis. Insurance companies also have built into their own systems incentives for people to abuse health care. Many insurance companies require co-pays for office visits, but none for ED visits even if the ED visit is for a non-emergent condition and knowing that the charges in an ED will be much higher than if seen in a clinic setting. Furthermore, they won't pay 80 dollars a month for an oral medication but will pay 1600 dollars a month for someone to come to an outpatient setting to receive the same medication as an injection or IV form. I agree that health care is important and "should" be a priority for everyone, but I also think that the current "fix" has as many problems in different forms as our old system. People need to be accountable for their health care, insurance companies need to be more vigilant in monitoring abuses in the system and deal directly with the individuals who abuse. Let's face it, if a client has 15 to 20 ED visits per month, something needs to change. So, I'll shut up now. LOL
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Deleted
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Post by Deleted on Jun 28, 2012 21:03:17 GMT -5
One last item.....
With 30 million new people paying for the health care system...and the same number of doctors we already had, what do you suppose waiting times for doctors will now be?
For those that believe care will not be diminished, you may be shocked
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chiver78
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Post by chiver78 on Jun 28, 2012 21:08:04 GMT -5
For those that believe care will not be diminished, you may be shocked this is not at all intended to be a snarky, flippant reply. I seriously want to know whether it is more important to you that you be seen NOW, DAMMIT! for every visit than it is that every single person legally in this country (citizens and legal immigrants) has access to affordable healthcare.
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Sharon
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Post by Sharon on Jun 28, 2012 21:12:36 GMT -5
The number of doctors who continue to practice will probably be diminishing also because of the reimbursement rates. One of the ways they are planning on covering all these uninsured folks is by increasing Medicaid. Medicaid and Medicare both have abysmal reimbursement rates. Then there is the whole Electronic Health Record issue. It is mandated that doctors start using EHR's and there are certain levels of "Meaningful Use" with compliance dates tied into this. If they do not meet these deadlines and can not prove Meaningful Use the doctors Medicare reimbursement rate will be cut even further. The EHR software also has to be certified as being compliant. There were monetary incentives for converting to EHR's and money made available to help cover the cost of converting to EHR's as part of HITECH but I think it was still out of reach for many single provider practices, if they even knew about it.
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fwjone819
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Post by fwjone819 on Jun 28, 2012 21:16:47 GMT -5
Health care for all is important. But there is an ongoing crisis of lack of family health care in rural communities already and a lot of doctors that have routinely covered rural areas are aging and cutting back or retiring all together to avoid increased cost of patient care. Also, new physicians coming out of schools are not looking at family practice because of high school loan payments. I think it will become increasingly hard to get into a doctor and that many ED's are going to be overwhelmed by those who can't or won't seek family physician care.
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Deleted
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Post by Deleted on Jun 28, 2012 21:23:03 GMT -5
I believe that "most" people that wanted healthcare, had a way to get it if they chose to
Of course...there were exceptions...arent there always
Some people chose driving a new car over it....some people wanted the ipad and iphone.....
Those that are "poor" and couldnt afford it, have medicaid to fall back onto
I wait like everyone else.....but my patience has limits
My insurance is through an HMO, and the waits can already be atrocious
This will make matters much worse
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Sharon
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Post by Sharon on Jun 28, 2012 21:32:19 GMT -5
Very little has been discussed about the part of PPACA that affects how doctors run their office. How claims are sent electronically, how you check for eligibility, how you are paid by the insurance companies. They took the HIPAA X12 regulations and have expanded on them and have mandated these wonderful little things called operating rules. Operating rules mandate such things as how soon an eligibility request must be returned, 20 seconds in case anyone wishes to know. They also designate that NACHA is the standard for electronic transfer of funds. The amount of money that insurance companies have poured into meeting these mandates is phenomenal. They have to recoup the money somehow. We all know it will be through premium payments. There is a huge push for everything to be done electronically. Just trying to keep up with compliance of the mandates is a full time job.
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rovo
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Post by rovo on Jun 28, 2012 21:48:48 GMT -5
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susanb
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Post by susanb on Jun 28, 2012 22:21:35 GMT -5
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TheOtherMe
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Post by TheOtherMe on Jun 28, 2012 22:38:17 GMT -5
If it's handled as a tax and based on income, wouldn't the logical place to collect it would be the IRS? If so, I'd expect that the same rules and penalties would apply to this tax as would all other tax you owe the IRS. And the IRS *can* enforce and collect outstanding tax (and throw people in jail for evading it). I'm not going to discuss the politics of the ACA. I am a retired IRS agent and several friends of mine have been getting trained on the implementation of the ACA who still work at the IRS. A new section at the IRS has been set up to handle this. However, the wording of the act itself says that no liens can be filed against a taxpayer for the "penalty".
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Sum Dum Gai
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Post by Sum Dum Gai on Jun 28, 2012 23:24:52 GMT -5
With 30 million new people paying for the health care system...and the same number of doctors we already had, what do you suppose waiting times for doctors will now be? I'm actually really curious to see how that will play out. In theory a somewhat large percentage of those uninsured people have some kind of medical condition that they previously couldn't get routine treatment for, but they still went to the ER when necessary. Another fairly large chunk are young healthy people that by and large won't use the insurance they're forced to buy anyway. The first group would presumably be in the doctor's office more to manage their conditions, but they wouldn't be in the ER as often. The second group won't really matter since they're healthy anyway. We could see longer waits at the doctors office, but shorter waits at the ER, which in my opinion would be a good thing. I hate waiting for an appointment as much as the next guy, but I really want less clogged ER's because my life is on the line when I'm going there. If I have to wait an extra 15 minutes to go get my prescription for an antibiotic to treat my strep throat so be it. I also know plenty of people that seem to be in the doctor's office every two weeks for some minor complaint or another. With longer waits maybe they'll decide to put on their big kid panties and only make an appointment when they're actually sick sick, and not just because they have the sniffles and need to take it easy for a day. In theory.
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resolution
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Post by resolution on Jun 29, 2012 0:23:43 GMT -5
I have spent some time reading portions of the bill. You can find summaries of the policies here www.healthcare.gov/law/features/index.html The law itself is here housedocs.house.gov/energycommerce/ppacacon.pdf but it is very boring and long. If the bill had passed the supreme court as it stood, all people under 135% of the Federal Poverty Level (FPL) would have been eligible for Medicaid. However if they didn't apply for it they wouldn't have insurance coverage. They would be in the same boat they are today (although most likely the hospital would sign them up for medicaid when they were admitted). With today's ruling it will be up to the states if they want to take the Medicaid money and add these people. Everyone that had access to an "affordable" employer plan that was above the medicaid limits would need to buy it. Each state would set a benchmark plan to measure the services provided and determine "affordability" based on employee's household incomes. They were talking about changing this to be based on the employee wages rather than the employee's household, since employers can't control the households of the employees. If the employee doesn't buy a plan (or get on a family member plan) then they don't have coverage. Everyone without an "affordable" employee plan can buy insurance off the health exchange. To be eligible for a tax credit the person needs to apply for Medicaid and be denied, and must be between 135% and 400% of the FPL. The cost the person has to pay ranges from 3% of MAGI on the low end to 9% of household MAGI on the high end. To get a rough idea of MAGI, take your AGI off of taxes and add back in your IRA contributions. My personal opinion is that people are going to be upset when they find out they have to apply for Medicaid and they will also be upset when they have to pay 9% of their income for medical insurance before the subsidy kicks in. I know I was a bit dismayed when I realized that my household was way over the income limits for any credit, and I don't even consider that I make very much. I was thinking the whole middle class would get some help but it seems to cut off at lower middle income.
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whoisjohngalt
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Post by whoisjohngalt on Jun 29, 2012 0:39:02 GMT -5
Well, I don't know about others, but I don't want to wait for 2 hrs to see a dr. If I am at the dr's office, there is a good reason for it and waiting and waiting and than waiting some more is not as "painless" as it might seem. Waiting with a sick child is 100 times worse.
Also, this term "affordable healthcare" is being thrown around a lot. Affordable to whom?
And I lived in MA for 2 yrs - and I had hell of a time with dr's offices. Not only it was almost impossible to find drs who accepted new patients (OB, pediatrician and general practitioner), the wait time was insane. May be it was just my bad luck, I don't know or may be it was just one big coincidence. I started to wish that I was back in MD, and I REALLY don't like MD.
Lena
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DVM gone riding
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Post by DVM gone riding on Jun 29, 2012 9:25:57 GMT -5
Does anybody remember the employee size limit for small businesses that would exempt them from being fined? I don't see how this would give incentives to small businesses to purchase healthcare for their employees, just another thing to ponder. 50, I believe I don't really see what difference it makes. I work in an office of 10 people right now and have excellent insurance. Why would this policy stop my employer from providing healthcare? There is about 15 of us and I am concerned that obamacare as a whole will cause my employer to stop coverage. Every year our premiums rise, and every year he asks us to pay a little more, the first year of Obamacare it rose 20+%!!! Because they had to adjust for the "free" preventive care mandates. If not right now, soon he will get a tax benefit for providing us insurance, at some point though the cost could be high enough he drops us and tells us to have "fun" with the exchanges, besides the doctors the rest of the staff might actually qualify for "supplements" not sure where those are kicking in at.
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milee
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Post by milee on Jun 29, 2012 9:56:04 GMT -5
There seems to be a disconnect between what people think employers will do regarding dropping employee insurance. It appears more business owners, people in management and with upper level financial experience view this as likely to probable, yet people who are not business owners, in management or with upper level financial experience don't think the businesses will make this change. Hard to tell where the disconnect is happening.
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zibazinski
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Post by zibazinski on Jun 29, 2012 10:02:15 GMT -5
I don't think it's hard. Employees, and I have been one as well as on the other side, have no idea what it really costs and employer to have them as an employee. They think it's just their salary and health insurance whereas it's a lot more involved than that. DF talked to his insurance agent yesterday and they are already making new plans. This will save him a bundle and really hurt the employee who is going to have a very hard time getting any insurer to cover him, no matter what the givt says that he has to be insured.
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chiver78
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Post by chiver78 on Jun 29, 2012 10:02:19 GMT -5
Well, I don't know about others, but I don't want to wait for 2 hrs to see a dr. If I am at the dr's office, there is a good reason for it and waiting and waiting and than waiting some more is not as "painless" as it might seem. Waiting with a sick child is 100 times worse. Also, this term "affordable healthcare" is being thrown around a lot. Affordable to whom? And I lived in MA for 2 yrs - and I had hell of a time with dr's offices. Not only it was almost impossible to find drs who accepted new patients (OB, pediatrician and general practitioner), the wait time was insane. May be it was just my bad luck, I don't know or may be it was just one big coincidence. I started to wish that I was back in MD, and I REALLY don't like MD. Lena not quite what I meant by "NOW" - more that you wouldn't get the appointment immediately. having to wait once you're already there is not at all related to whether the ACA was upheld or not, it has to do with poor planning in your dr's office.
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Deleted
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Post by Deleted on Jun 29, 2012 10:04:46 GMT -5
There seems to be a disconnect between what people think employers will do regarding dropping employee insurance. It appears more business owners, people in management and with upper level financial experience view this as likely to probable, yet people who are not business owners, in management or with upper level financial experience don't think the businesses will make this change. Hard to tell where the disconnect is happening. Employers were the only option for a lot of people concerning insurance....and it helped to recruit and retain good employees, when the benefits package was better than the guy down the street This changes that....there will be OTHER options.....and as management, i need to look at everything from the perspective of the owner. My job is to give advice on what is more prudent for him....not what is best for employees. Sometimes they are the same thing...and at other times, not. I dont think a great amount of thought was put into this aspect of the healthcare package....but it could be an awakening for a lot of people....
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zibazinski
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Post by zibazinski on Jun 29, 2012 10:05:31 GMT -5
DF has been hoping this guy will leave for a long time and now with not having to cover him and his wife, this will save the company 1600 a month. He says he will offer him a raise of a grand a month so after taxes, it'll be basically his health care that's covered and not his wife's. Good luck to him getting coverage for him and his wife for 800 a month. Anywhere. Imagine a 12k raise not being enough to pay for health insurance for two people.
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zibazinski
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Post by zibazinski on Jun 29, 2012 10:07:41 GMT -5
His insurance lady said that for them to cover his wife and himself would be over 2200 a month because of their weight and health so there is still going to be those issues going on. Obamacare changed nothing but is going to hurt a fair amount of people.
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milee
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Post by milee on Jun 29, 2012 10:09:30 GMT -5
DF has been hoping this guy will leave for a long time and now with not having to cover him and his wife, this will save the company 1600 a month. He says he will offer him a raise of a grand a month so after taxes, it'll be basically his health care that's covered and not his wife's. Good luck to him getting coverage for him and his wife for 800 a month. Anywhere. Imagine a 12k raise not being enough to pay for health insurance for two people. This exact scenario is why - as much as it pains me to do so - we avoid hiring people with obvious health risks, like obesity. I'm aware how awful that sounds and how most people's reaction is to rip into the "greedy" business owner, but seriously, does anyone think it's reasonable to ask a single small business owner to pay an extra $19k a year more than the average cost for health insurance for a single employee?
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lynnerself
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Post by lynnerself on Jun 29, 2012 10:09:34 GMT -5
I work in a Physicians Clinic. I know they are committed to continuing coverage. It has been stated by management and providers.
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zibazinski
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Post by zibazinski on Jun 29, 2012 10:12:15 GMT -5
DFs doctor is going to concierge care. He didn't want to and his wife is vehemently opposed to it but now it's a given.
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zibazinski
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Post by zibazinski on Jun 29, 2012 10:13:39 GMT -5
Even years ago when we first started our business, we didn't offer maternity and didn't hire anyone that smoked. Not too many people were fat then but we had very basic bare bones insurance coverage because that was what we could afford to offer employees.
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NomoreDramaQ1015
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Post by NomoreDramaQ1015 on Jun 29, 2012 10:16:20 GMT -5
I also know plenty of people that seem to be in the doctor's office every two weeks for some minor complaint or another. With longer waits maybe they'll decide to put on their big kid panties and only make an appointment when they're actually sick sick, and not just because they have the sniffles and need to take it easy for a day. My MIL is like that and maybe just maybe if it costs her more in insurance coverage to be able to be at the doctor's every five minutes she might think twice. Like Lynn my employer has stated they plan on continuing coverage and also stated they have been working for the past couple years on making changes BEFORE they became law. Besides putting DH/Gwen on my insurance I haven't seen any rise in my costs. The university just saved itself millions by doing an audit (I forgot the exact number). We're going to see a rise but that isn't do to the new healthcare laws it is because our employer has chosen to extend benefits to non-married couples and the price needs to rise to cover that.
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thyme4change
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Post by thyme4change on Jun 29, 2012 10:21:36 GMT -5
To basically repeat what gdgyva said - the fine isn't the motivator. The motivator is that now the government is requiring insurance companies to cover everyone - pre-existing conditions, health problems, age, etc, are no longer exclusions. Employers offered benefits to attract people who maybe had a kid with diabetes, a wife with fibromaylagia or an employee who successfully beat cancer 5 years. Those people can't just walk out the door and be insured - they are also the least likely to take a chance and be uninsured. Now that those workers can find other options, it is less effective as an employee benefit. Also, those same employees can't complain that they 'can' get coverage, but they can't afford it, because it will be subsidized.
Basically, the changes in how private, individual insurance is going to work - by law - takes the guilt and incentives away from employers. There are now options.
Now, if only they could change IRAs to $16,500 - we could break the employer relationship with tax incentived retirement investing.
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