Gyroscopic Investing

I thought I'd start a thread where we could document all the ways Obamacare has impacted out lives.  I've seen a couple of threads about some specific new taxes, but this gives us a places to document them all.

1. Increased price of insurance due to coverage mandates.  This is an old one and I'm mostly over it by now.

What made me want to start this thread is #2 and #3.

2. My wife has recently had her hours cut to 29 per week in order to avoid some arbitrary Obamacare cutoff point for providing insurance to part time workers.  She is a Title One Teacher, which at the school she's currently at is an aide position, rather than full time.
3. Because of the "thou shalt not work enough hours to qualify for insurance!" policy, my wife was just rejected from the tutoring program, of which she was one of the few who signed up.  It's an after hours tutoring program that pays an extra $1000 per semester.

The best part is, she hasn't been on the school's insurance since she started there!  My job provides MUCH better health insurance than this crummy school, but there's no flexibility, no exemption, no reasoning, just the productivity killing bureaucracy of Obamacare.

Good thread

1. My primary care doctor sold his private practice to the local hospital. He is now an employee of the hospital. No direct impact on me yet.

2. My dermatologist stopped accepting any non-cosmetic cases
3. My friend, an anesthesiologist, is retiring early.

My mom is now insurable at the age of 60.

Edit: she isn't yet but will be soon if the law holds.

Well, next year, I hope to be posting that I was able to shop around for better health insurance, or at least better value.

So far, the only effect has been some checks from health insurers because they exceeded the maximum amount of money that can be spent on pencil pushing rather than healthcare, and I think I already posted about these checks.

Although this household will probably benefit, I am pretty well-informed about what a mess ACA is.

No effect on me yet AFAIK.

My parents won't have to worry about being dropped by insurance company if they get sick. I think the cost of their health insurance is expected to decline...but we shall see.

+ Got to keep my son an extra year on my company insurance.
- Now he's buying his own insurance, with very high deductibles to make it affordable to him. Not sure yet if that will get better, he lives in TX.

As an employee benefits consultant, I see Obamacare squeezing employers out of providing health insurance of any kind to their employees in exactly the same way that ERISA squeezed employers out of providing traditional defined benefit pension plans to their employees.

It may take 10-20 years (it took ERISA 40 years to exterminate private sector pension plans), but Obamacare may ultimately save employers a fortune by allowing them to stop providing coverage altogether and shift yet another expense and risk to their employees.

A little off topic, MT....what incentive would American companies have had today in a a global labor marketplace to continue to provide pension plans for employees?

doodle wrote: A little off topic, MT....what incentive would American companies have had today in a a global labor marketplace to continue to provide pension plans for employees?

The same incentive that they have to pay them wages.

1) I read a lot of hyperbole about the effects of Obamacare on the Internet.

2) I no longer worry about losing my job and health insurance, being unable to afford regular care, and getting free medical care in the ER after my condition worsens, driving up medical costs for all.

I am an owner/operator of a small business.  We offer health insurance for about 30'ish employees.  In each of the last two years, we've had SIGNIFICANT cost increases.  I'm talking around 25% increases back to back years.  We've had to decrease the percentage of premium that we pay passing much of the cost to our employees.

We've shopped providers and brokers, so these are the types of increases we're seeing after shopping.  They all say the same thing..... Obamacare.  And the other thing they say is that it's going to get worse for the foreseeable future.

If the trend continues, or the employer mandate kicks in, we'll have to drop coverage for spouses that work.  If that's not enough, we'll reduce full time employees and possibly eventually drop coverage completely and pay the fine.  Even though I previously said we offer roughly 30 employees coverage, we also have an additional 50 or so employees that work about 30-38 hours/week, and an additional 120 or so that are less than 30, so we qualify as a "big business" as defined by Obama.  If you saw our P&L you would know were are not a "big business".

MediumTex wrote: As an employee benefits consultant, I see Obamacare squeezing employers out of providing health insurance of any kind to their employees in exactly the same way that ERISA squeezed employers out of providing traditional defined benefit pension plans to their employees.

It may take 10-20 years (it took ERISA 40 years to exterminate private sector pension plans), but Obamacare may ultimately save employers a fortune by allowing them to stop providing coverage altogether and shift yet another expense and risk to their employees.

I've never seen why it would be desirable (from a policy perspective) for health insurance or retirement planning to be tied to your employer. 

Great thread.

MediumTex wrote: It may take 10-20 years (it took ERISA 40 years to exterminate private sector pension plans), but Obamacare may ultimately save employers a fortune by allowing them to stop providing coverage altogether and shift yet another expense and risk to their employees.

I wonder if that's actually the intention.  Maybe it's not a bad thing to replace employer health care costs with an extra payroll tax, so that responsibility will devolve onto the individual.  Although, I'm not clear on where that payroll tax ends up.

As far as my personal experience with Obamacare:

1. The Good:  It's nice being able to reassure patients that they are not screwed for life by having a very expensive pre-existing condition that tends to crop up in the teens/twenties.

2. The Bad:  The EHR mandate has been a disaster for everyone except lawyers.  It has not and will not accomplish the goal of making medical data available across centers.  The EHR programs are, quite simply, badly designed beta software and the companies have zero incentive to improve.  Between this and the new "PQRI" mandates among other things, the time physicians and nurses must spend documenting has gone up drastically.  Residents at my hospital have said that they now spend about 3/4 of their time wrestling with the computer. Also, patients have been directly harmed by the bugs in the software, although thankfully I don't know of anyone who has died.  The only plus is that it's helped to increase billing (percentage of encounters billed + higher levels of service), which has been documented to increase Medicare claims by a significant amount (forget how much exactly).

3. More bad:  HIPAA was ramped up to include criminal penalties.  It was passed as part of the stimulus package, but you can consider it an aspect of Obamacare.  It has caused mass hysteria regarding health care data access, with draconian security measures implemented by medical center IT centers (who, shall we say, do not exactly hire the best & brightest).  It's also making research protocol approval a far more difficult process, so that now IRB departments have greatly expanded and research groups must hire people specifically to deal with IRB issues.  More expenses at a time when research dollars are shrinking.

4. Yet more bad:  PCORI, as per previous post.  It's an additional tax on employers and effectively siphons money away from NIH.  And it has nothing whatsoever to do with improving health care access.

MangoMan wrote:

WiseOne wrote: The Good:  It's nice being able to reassure patients that they are not screwed for life by having a very expensive pre-existing condition that tends to crop up in the teens/twenties.

What about pre-existing conditions that are the result of poor lifestyle choices [smoking, obesity, etc]? Would you consider that a "good" also? I get why everyone should pay more in costs for the former, but why should we pay more for the latter? Thoughts?

"What about pre-existing conditions that are the result of poor lifestyle choices [smoking, obesity, etc]? Would you consider that a "good" also?"

What you want people to start taking responsibility for their actions?  Doesn't sound fair to me 


If you are covering people for any pre-existing conditions, it does not fit the definition of the word insurance.  It is then charity.  Now I'm all for charity, as long as you call it that.

I have an individual plan and was not due for any changes until May 2014. My insurance company offered me the opportunity to keep my current benefits and rate if I renew the plan for the year December 31, 2013 through December 31, 2014. After that time I -must- switch to an ACA compliant plan.

Or I could have switched right now. The new plan looked a bit worse (out-of-pocket co-insurance limit increased from $2500 to $6350) but included the ACA's "essential health benefits" and it's going to cost me 75% more.

MangoMan wrote:

WiseOne wrote: The Good:  It's nice being able to reassure patients that they are not screwed for life by having a very expensive pre-existing condition that tends to crop up in the teens/twenties.

What about pre-existing conditions that are the result of poor lifestyle choices [smoking, obesity, etc]? Would you consider that a "good" also? I get why everyone should pay more in costs for the former, but why should we pay more for the latter? Thoughts?

If you can separate the deserved vs. undeserved conditions in individuals effectively and fairly, more power to you.  Note that they sometimes occur as a result of genetics (e.g. familial hypercholesterolemia or Prinzmetal's angina), or with genetics as a contributing factor (e.g. hypertension in the African-American population whose ancestors arrived on slave ships, which selected for sodium retention), or due to other medical conditions (hypothyroidism).  If it helps, a smoking history gets you a higher insurance premium under Obamacare. 

Speaking of "lifestyle choices" - would you then refuse coverage to someone injured while skiing or rock climbing?  That's a "lifestyle choice" too.  Healthier and better regarded by society, true, but the principle is the same.  And what if you were riding a bike to work and got hit by a car?  Is that not also a lifestyle choice?  You see where this reasoning gets you?  It sounds nice, but in practice it would be a nightmare to implement.

moda0306 wrote: My mom is now insurable at the age of 60.

Edit: she isn't yet but will be soon if the law holds.

Just need to correct the logic here. She isn't made insurable by the law. Laws cannot make you insurable. She will be the beneficiary of subsidized insurance paid for by others. Her cost will be lower because others will suffer higher costs or lost employment. That's what really is happening. Of course I'm not blaming her. Health care costs are obscenely high because of constant government intrusion. We are all poorer because the government weakens the economy and makes saving less appealing through inflation.

Government/Violence/Theft creates the problem, then proposes more Government/Violence/Theft  as the solution. This makes the problems worse and/or creates new problems to which Government/Violence/Theft is then proposed as the solution.....rinse/repeat.

It's easy to see the obvious benefit to the recipients of the Government's stolen booty but the challenge is to see the ill effects on others which are less obviously apparent.

Of course just understanding the kindergarten morality that stealing and hitting is wrong avoids all this. Sadly these lessons are unlearned by most as they age.

MangoMan wrote:

WiseOne wrote:

MangoMan wrote: What about pre-existing conditions that are the result of poor lifestyle choices [smoking, obesity, etc]? Would you consider that a "good" also? I get why everyone should pay more in costs for the former, but why should we pay more for the latter? Thoughts?

...a smoking history gets you a higher insurance premium under Obamacare. 

Speaking of "lifestyle choices" - would you then refuse coverage to someone injured while skiing or rock climbing?  That's a "lifestyle choice" too.  Healthier and better regarded by society, true, but the principle is the same.  And what if you were riding a bike to work and got hit by a car?  Is that not also a lifestyle choice?  You see where this reasoning gets you?  It sounds nice, but in practice it would be a nightmare to implement.

I wouldn't refuse coverage, but I would expect a higher premium for people who participate in  'risky' activities. That's what they do for life and disability insurance.

Yeah but what if a lot of people who engage in "risky" activities say they will vote for you. Then the choice is clear. You must steal from others to buy their votes.

Kshartle wrote: It's easy to see the obvious benefit to the recipients of the Government's stolen booty but the challenge is to see the ill effects on others which are less obviously apparent.

With Obamacare, the ill effects on others are far, far less "unseen" than your typical unintended consequences.

Benko wrote: If you are covering people for any pre-existing conditions, it does not fit the definition of the word insurance.  It is then charity.  Now I'm all for charity, as long as you call it that.

Is health coverage via employer (which even before the ACA cannot deny coverage based on preexisting conditions) insurance or charity?

Tyler wrote: Is health coverage via employer (which even before the ACA cannot deny coverage based on preexisting conditions) insurance or charity?

It's not insurance, but I wouldn't call it charity; more of a job perk. I mean in some cases they pay 100%!

PS,

Isn't it still insurance, then, but just with a $0 deductible?  It's just a matter of what size of risk you want to retain vs transfer, correct? 

I'm not saying that's how I'd prefer to build my own health insurance plan, but it seems to me that the lack of a giant deductible doesn't necessarily make it "not insurance."  In my book, as long as it covers the big stuff, whether it covers the small stuff or not, it's "insurance."  You've simply transferred 100% of the financial risk of a medical event instead of building up a risk-retainage mechanism via a deductible.

Now my girlfriend at one point was offered a "health insurance" that she could opt into where it would cover the first $5,000 of her medical expenses, but no more.

I shook my head in disbelief... now THAT is the opposite of insurance.

Tyler wrote:

Benko wrote: If you are covering people for any pre-existing conditions, it does not fit the definition of the word insurance.  It is then charity.  Now I'm all for charity, as long as you call it that.

Is health coverage via employer (which even before the ACA cannot deny coverage based on preexisting conditions) insurance or charity?

Health coverage via employer is neither insurance or charity. It is voluntary payment or compensation for services rendered. It is more valuable than increased pay because the recipiant doesn't have to pay taxes on it. The tax policy has distored and bound insurance coverage to employement this way. It is not market-driven.

Pointedstick wrote:

Tyler wrote: Is health coverage via employer (which even before the ACA cannot deny coverage based on preexisting conditions) insurance or charity?

It's not insurance, but I wouldn't call it charity; more of a job perk. I mean in some cases they pay 100%!

One way that the ACA may help me is it will allow me to retire early (or at least take a few years off to travel) and not live in fear that a preexisting condition will force me into a job I no longer need just for medical care.

I still don't think the law is well written.  But I also don't buy the "insurance vs. charity" argument, as the system we have now for the vast majority of people isn't really insurance, either.  Noone seems to complain about mandatory-issue laws for group coverage driving up rates for everyone else by automatically insuring already sick people. 

At the very least, I think the same rules (if you have continuous coverage you can switch insurance providers and move states with no issues) should apply to both the private and corporate markets.  Please correct me if that's already the case and I just have missed it.

moda0306 wrote: PS,

it seems to me that the lack of a giant deductible doesn't necessarily make it "not insurance."  In my book, as long as it covers the big stuff, whether it covers the small stuff or not, it's "insurance."  I shook my head in disbelief... now THAT is the opposite of insurance.

The premium is what makes it insurance, not the deductible. The deductible is just the portion of the cost that the insurer doesn't pick up. Don't view it as a payment to the insurance company but instead as a portion of the health care costs required.

A plan without any premium is charity. A plan where the employer pays 100% of the premium is still a plan because you are just replacing wages with the premium and it's part of the compensation package.

A plan with no deductible is in reality just pre-paid medical. If the consumer has no net additional cost they will consume as much as they possibly can. This is a disaster that pretty much only the government would undertake. All the inevitable losses are borne by a third party.......everyone but the government.