Supreme Court Might Decide Their Second Election

[Yo_Mama]

24. I don't think this is a stupid example at all

I think you very precisely described what's happening.

But what happens to the young underemployed with the large student loans? I can't see how many of them can afford to pay their student loans, pay for insurance and do anything else. Older people with generally higher incomes but higher bills and much higher medical costs will be in trouble too.

People are strapped.

And no one can really tell anyone how much they have to pay, because the copays under the law are too damned high. If you actually need medical care, you're in trouble. This is not the reform the average American was looking for:
http://healthreform.kff.org/SubsidyCalculator.aspx

Here's what take-home pay would like for a single person, 23, no dependents, $25,000 annual income:
http://www.calculator.net/take-home-pay-calculator.html?cannualincome=25000&cpayfrequency=Annual&cfilestatus=Single&callowance=1&cdeduction=0&cstatetax=6&ccitytax=0&cadditionat1=no&x=68&y=6

After-tax income something like $19,734. From that, such a person has to pay $1,726 (or thereabouts) in insurance premiums. But the estimated real premium is over 4K a year, and we still don't know when and how this person is going to get the tax credit of $2,342 that's supposed to make up the difference. If it's not credited back in the paycheck (and I have no idea how that would work), then how? Because if the person has to pay upfront and wait a year, that person is in trouble.

But the real joy happens if this person runs up 10K in med bills, which these days can be one ER visit (suppose you fall off your bike and crack your skull). The actuarial payout is on the order of 73%, which means the average cost to the person will be another $2,700.

Is that really affordable? 22% of your income for medical?

And what about people with very fluctuating incomes? No one's explained how that works.

As a plan to really get people medical care, I don't think it works. I think it was a good first step, but what the final bill added up to was a lot of protection for hospitals and insurance companies, and very little protection for the consumer.

Now figure that this person is paying $250 a month on student loans, and after that payment their annual take home pay is 16,734, or $1,394 a month. From that they are supposed to pay car payment, auto insurance, medical bills plus the medical premium.

It gets way worse when you look at older people. Way, way worse. For a 62 year old single, no dependents, with an annual income of $48,000, the insurance premium is supposed to be $12,000 annually. On top of that, the out-of-pocket cost is $6,250. The actuarial payout is 60%, so if they have 10K of medical bills they can expect to pay $4,000 out of pocket. So that's total medical bills of $16,000 annually, and after taxes, tax home pay should be around $36,650. So are they really going to pay over 43% of their income on medical expenses? If the person is self-employed, the extra FICA/SECA tax drops the take home to $33,885, taking medical payments to over 47% of income.

Hell, the average homeowner who has paid off his/her mortgage in some high-tax states (think NJ) pays property taxes in excess of $7,000.

The reality is that many people won't be able to afford both the insurance and medical care. You have so many people working temporary jobs. They don't know from month to month what their income will be. You've got tons more working in retail with highly fluctuating incomes because the hours fluctuate.

I'm sorry, we always said it would be "fixed later", and IMO it's time to begin fixing it. We urgently need reform of the health care system, and the economic realities are still mostly getting worse.

The plan's really good if you are high income, because it guarantees you access to lower cost insurance due to folding in all the young folks. It's really good if you are low income, like making 14K a year, because you get Medicaid (although it's increasingly difficult to actually get medical care on Medicaid). It sucks for the vast majority of the people who will be thrown on the exchanges - those working in lower paid jobs, temporary jobs, self-employed.

That's why CBO keeps changing its estimates to more uninsured people - at last estimate, over 26 million.
http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf

Compared with prior law, the ACA is now estimated by CBO and JCT to reduce the number of nonelderly people without health insurance coverage by 30 million to 33 million in 2016 and subsequent years, leaving 26 million to 27 million nonelderly residents uninsured in those years (see Table 3, at the end of this report). The share of legal nonelderly residents with insurance is projected to rise from 82 percent in 2012 to 93 percent by 2022.

9% - that's how much this act is supposed to reduce the uninsured. In fact, CBO estimates that in 2014, the share of insured US legal residents with rise from 80% in 2013 to 86%. More than 50% of that comes from the additional Medicaid enrollees.

I'm so tired of people pretending that this act does things it doesn't do. The purpose of insurance is so that people can access medical care. If it fails at that purpose, it's a failure.

I guarantee you that a lot more people will be defaulting on loans if this bill goes into effect! The problem is that this bill does not protect sick people.