Monthly Archives: September 2013

Poll: Most will get health insurance

Poll: Most will get health insurance – Tal Kopan –

Asked whether they plan to get insurance when the requirement takes effect or pay the fine for not doing so, 65 percent of uninsured Americans said they would get health insurance, according to a Gallup poll out Monday. Twenty-five percent said they would pay the fine.

Gallup also asked about the whether those individuals planned to use the exchange markets that launch Tuesday to buy their insurance. Almost half, 48 percent, said they planned to use the exchanges, 36 said they did not and 17 percent weren’t sure.

If these uninsured want a government subsidy, then they will have to use the exchange.


Colorado: Subsidy 60 year old couple

This subsidy chart for a 60 year old Colorado 26 year old Colorado couple was created using the updated subsidy calculator on the Colorado Marketplace, Connect for Health Colorado. Boulder is fairly typical for the state and Edwards/the Vail Valley is indicative of the resort areas.


Subsidy graph 60 year old Colorado couple

As you can see thee are significant subsidies for all levels of MAGI. The subsidy cutoff level is a MAGI of $62,040, although the last value I plotted was $61.750. Using the latter as the cutoff level, an interesting question to ask is what is the penalty for making $1 more than the cutoff?

The annual penalty, measured in terms of lost subsidy, for making one additional dollar above the cutoff level is based on the subsidy level right below cutoff. This is shown below:

Boulder: Subsidy at cutoff – $586/mo

Edwards: Subsidy at cutoff – $1457

Annual penalty for making $1 above the cutoff level…

Boulder – $7032

Edwards – $17,484

Wow, it seems to me there will be lots of income management going on for older couples near the threshold. Talk about a disincentive to make more money. We’re from the government and we’re hear to help.


Colorado : 26 year old young invincible subsidy

This young invincible subsidy chart for a Colorado 26 year old was created using the updated subsidy calculator on the Colorado Marketplace, Connect for Health Colorado. Boulder is fairly typical for the state and Edwards/the Vail Valley is indicative of the resort areas.

Colorado Young invincible Subsidy

In general, young invincibles in Colorado that have a modified adjusted gross income greater than $27,500 or $30,000 will receive no subsidy. Edwards is a dramatic exception which is due to the cost of health coverage being substantially more expensive in the resort areas.


What You Need to Know About the Affordable Care Act

What You Need to Know About the Affordable Care Act –

  • If you need insurance
  • Plans
  • Tax Credits
  • If you need help
  • The fine
  • Medicaid
  • Protections
  • Kids and women
  • Businesses

And let me add once again…

  • If your income is greater than 400% of the Federal Poverty Level, all exchange plans plus additional plans are available off the exchange.

These plans are the same Qualified Health Plans covering the 10 Essential Health Benefits and are guaranteed issue with not pre-existing exclusions. They have the same Bronze, Silver, Gold and Platinum coverage options.


11 Pieces of Obamacare Conventional Wisdom That Shouldn’t Be So Conventional – Bloomberg

11 Pieces of Obamacare Conventional Wisdom That Shouldn’t Be So Conventional – Bloomberg.

  1. Once Obamacare goes into effect, it will be impossible to substantially cut it back.
  2. Accountable Care Organizations are certain to bring down overall health spending
  3. Obamacare works because it gets money from deadbeats who go to the emergency room and then stiff the rest of us for the cost.
  4. Emergency room use will decline.
  5. People can game the system by going without insurance and then buying it when they get sick.
  6. Breaking the link between health insurance and employment will spur entrepreneurship.
  7. Obamacare will reduce the budget deficit
  8. The Independent Payment Advisory Board is going to radically change the relationship between you and your doctor.
  9. People with pre-existing conditions will be able to buy insurance in the private market for the first time.
  10. Obamacare will bend the cost curve.
  11. Obamacare will make bankruptcy a thing of the past, at least for the people who gain coverage.

I disagree with point #9 by the way. In general if you have a serious pre-existing condition, the only way to procure coverage was to sign up with the state risk pool. Perhaps that’s what Megan did and she wasn’t aware?


10 things Health Exchanges won’t tell you

10 things Obamacare won’t tell you – 10 things – MarketWatch.








  1. You might want to avoid signing up on Day One
  2. Yes, some workers are being required to use exchanges – but not these exchanges
  3. Expect to be confused
  4. Don’t bother asking our staff for recommendations
  5. Blue states do it better
  6. Abuse our honor system at your peril
  7. You’ll still pay for this, even if you don’t use it
  8. We’re a magnet for hackers and con artists
  9. You might not be able to keep your doctor
  10. Competition is for the greater good – except when there aren’t any competitors

and I would like to add number 11….

 11. If your income is above 400% of the Federal Poverty Level, there is no need to shop on the exchange. Exchanges are for subsidies and to determine eligibility for expanded Medicaid and CHP+.



Neil Cavuto to “Mr. President, We at Fox News are not the Problem”


Neill starts out…

Mr. President, Fox News isn’t what’s making American’s sick about your health care law…  your health care law is.

Neill touches on the following points…

  1. “If you like your doctor, you will be able to keep your doctor. Period.”
  2. Fox news didn’t push most of those companies to hire part time workers, your health care law did.
  3. Fox news didn’t incentivize fast food restaurants to scale back their benefits, your health care law did.
  4. Fox news didn’t make doctors want to opt-out, your health care law did.
  5. Fox news didn’t make insurance premiums skyrocket, your health care law did
  6. Just like Fox news didn’t grant 100’s of exemptions to companies that needed them, you did
  7. …and Fox news didn’t delay one key provision after another, including just today, on-line enrollment for small business exchanges, you did that sir.
  8. Just like it wasn’t Fox news that declared we had to pass this to see what was in it…

and the list goes on…

and Neill concludes that the skunk smell IS your law.


House votes to delay Obamacare for a year, government shutdown looms

House votes to delay Obamacare for a year, government shutdown looms –

House Republicans pushed through a spending plan early Sunday morning that would delay Obamacare for a year and repeal its tax on medical devices, increasing the chances of a government shutdown Tuesday because Senate Democrats have said they will reject the measure.

Passage of the amendments sends a temporary budget resolution back to the Senate, where Democrats vow to again block the anti-Obamacare amendments.

President Barack Obama has added a veto threat to that position

The real fun is about to begin!


Triggering Events for a Special Enrollment Period

Normally you will only be able to apply for ACA plans only during the open enrollment period. An exception is if there is a qualified triggering event. In the case of a triggering event, a Special Enrollment Period (SEP) is opened. Events that permit a SEP include but are not limited to:

  • Gaining or becoming a dependent
  • Gaining status as a citizen, national, or lawfully present individual
  • Loss of minimum essential coverage (e.g., loss of Medicaid eligibility, termination of a QHP), except if enrollment is terminated based on failure to pay premiums
  • Loss of affordable employer-sponsored coverage
  • Determination that an individual is newly eligible or ineligible for premium tax credits or a change in eligibility for cost-sharing reductions
  • Permanent move to an area where different QHPs are available
  • Other exceptional circumstances identified by the Marketplace

In most cases, Special Enrollment Periods will extend for 60 days from the date of the triggering event. Under certain circumstances, such as the pending loss of minimum essential coverage due to the termination of a QHP, a SEP may begin before the triggering event takes place.


ObamaCare Sign-Up Rules Would Reward People Who Fudge Income

ObamaCare Sign-Up Rules Would Reward People Who Fudge Income –

This article is about how the Cost-Sharing Reduction (CSR) benefits change on a Silver plan based on income. CSR benefits are available ONLY on Silver plans if your income is below 251% of the Federal Poverty Level. There are 3 ranges of CSR corresponding to FPL of 100% – 150%, 151% – 200% and 201% to 250%. The lower the range, the higher the CSR.


In California, for example, a childless married couple stating income of $30,000 would face a $1,000 deductible, $15 per primary care visit and a maximum out-of-pocket cost (after premiums) of $4,500.

But for a couple attesting to $32,000 in income, the deductible would be $3,000, primary care visit $40 and out-of-pocket maximum a hefty $10,400.

Though they are separated by just $2,000 in income, the government might provide the lower-earning family as much as $5,900 more in cost-sharing subsidies to defray deductibles and copays.

So what are the odds and ramifications of income fudging?

If the IRS subsequently finds out that households understated income, any excess premium subsidies can be taken out of federal income tax refunds. On the other hand, any excess subsidies paid out to reduce cost-sharing (deductibles and copays) would be water under the bridge. Households that overstate income would likely be in the clear for both premium and cost-sharing subsidies.

So in the example above, if an individual mistated their income by $2000, they would have to refund the extra premium subsidy, which would be a small amount. HOWEVER, if they access their benefits, any advantages they received under CSR is NOT an issue. There’s going to be a lot of “income fudging” going on.

The flip side of “income fudging”, as noted in the IBD article, is to increase your income to above 100% of the FPL (or 133% in states that have enhanced Medicaid) to become eligible for the premium subsidy and to stay off of Medicaid.

Chaos! The temptation for income fudging is going to be very high. Especially for families that have medical conditions and know they will be accessing benefits. We’re creating yet another new tag today, “income fudging”.