How exactly is this fine supposed to be enforced? Simply added to your taxes? For the record I think it's BS that I get fined for not giving my business to companies that I don't trust and are incentivized to screw me over. Signing up for Obamacare isn't signing up for health care, it's signing up insurance against grossly overpriced healthcare. Lets fix the problem, not play the insurance companies game.
The Supreme Court has ruled that the "fine" is a tax. As such, if you know you will be paying it, you are obligated to pay as part of your quarterly taxes. This unexpected requirement was made famous by Matt Drudge: https://twitter.com/DRUDGE/status/447057404568424448
I don't want to get in to ad hominem, but Matt Drudge is known to say untruthful things. In fact, that "unexpected requirement" is challenged by numerous people [0]. And of course, everybody already knew that you would pay a fine if you didn't buy insurance. Matt Drudge was not the one who discovered that.
> Matt Drudge was not the one who discovered that.
No; however, Drudge did post something about his taxes and everyone was like "OMG Matt Drudge is probably lying!!! There is no fine this year!!!" untilsome real analysts got on the line (e.g. the H&R Block people) who said "yep, that's about the state of things, if you're doing self-employed quarterly estimated taxes and the like. it's possible he is in fact overpaying, but there's really no formula the IRS has issued yet, so if he wants to be safe, that's what he'd do." and Drudge fears audits from the IRS, since he thinks that's exactly what they WOULD do to an administration critic.
I would add it's a series of taxes directed at the self-employed. If you work for a large company or for the state/federal government you'll have insurance already. If you're unemployed, you'll qualify for a subsidy or medicare.
The self-employed are already paying double in medicaid and social security (I know employers pay half for the employed but it still discourages self-employment).
I think you have it backwards. Because certain political elements didn't want to grant the authority to raise new fees, other political elements wrote the law under the existing authority to raise taxes. There's no disguise, it's openly taxes because that was the achievable goal.
Ideally you wouldn't have to pay for health insurance but this is what was able to be passed at this time. It has provided insurance to millions and largely reduced costs across the board. Everyone gets sick or at the very least eventually old. It isn't gambling, it isn't a risk, it's certain. You need to be insured. I'd just suggest it's better than what you had before.
It isn't gambling, it isn't a risk, it's certain. You need to be insured.
Why? I have money to pay my family's medical expenses. I've done very well investing it. Giving it to an insurance company whose primary goal is to not pay my medical expenses while collecting premiums over versus investing it myself for future payment of services rendered seems like a really bad trade. I realize this isn't a trade that every person is in a position to make, but why do I need the insurance? If I don't need the insurance, then why do I have to pay a fine to opt out of taking it from an insurance company?
I don't know many who are making an argument against lowering health costs or enabling access to more people. Neither of those things necesitate compulsory purchase of an insurance product.
This. I have enough to cover most things. Also I plan on doing any non-emergency procedures in another country where the prices are reasonable. Even if I do get hit with something catastrophic, I'd rather have them send me the bill and let me negotiate and pay it off myself. Insurance companies shouldn't be obligatory.
>Even if I do get hit with something catastrophic, I'd rather have them send me the bill and let me negotiate and pay it off myself.
You do realize medical bills can be in the millions of dollars, right? It isn't even vary hard to get into the hundreds of thousands. Requiring everyone to have insurance solves the "free rider problem," where some individuals pay less than others for the same thing. You can "negotiate" all you want, but that just means person A pays less than person B for the same thing. Especially if you get a $200,000 hospital bill and you had to declare bankruptcy. If there are a lot of Person As, it makes the costs for all the person Bs rise. If there is no incentive to be a Person B, then many people would be a Person A. Requiring insurance tries to eliminate the Person As.
Disclaimer: In the real world of US healthcare, prices are nuts and different for insured and uninsured.
> I realize this isn't a trade that every person is in a position to make, but why do I need the insurance?
Because most people can't deal with a $30,000 medical bill.
Also most people are, for lack of a better word, stupid. They don't make rational choices. My sister for example, thinks that she doesn't need health insurance because juice fasts can cure all diseases. How many of my sisters are out there vs people who are responsible with their money?
You may think you will be completely healthy, but really, we are all human and something terrible (and expensive) can happen to you tomorrow.
Do I think this is a good system or a good solution to the problem? No, I do not.
A lot of my resistance is due to the fact that I've been burned in the past by the fine print and ended up having to pay 80% instead of the agreed upon 20%. If I truly trusted that the insurance company would be there for me when I need them, I would have a different approach. As it stands I paid monthly insurance premiums + deductible + most of the bill. No thanks. I'll take my chances on my own.
Edit: For clarity, the insurance company decided to pay 80% of what they claimed the procedure was worth, not what it actually cost. Apparently there was something in the fine print about that.
>If I truly trusted that the insurance company would be there for me
I don't believe they will be there for me either, and I've been burned before too. That's one of the reasons why I don't support the ACA. However, making others take on your risk is any sane solution. You are just shifting the burden to others.
> As it stands I paid monthly insurance premiums + deductible + most of the bill
You can appeal and appeal and appeal, then go to your state insurance board. This is a government required right. There wasn't any reason to just accept what the insurance company told you. You can even get an external review. Over 90 percent of insurance decisions are reversed on appeal.
Just several phone calls sometimes resolves the issue. I've been on the phone so many times I've practically gotten them on speeddial.
If I don't need the insurance, then why do I have to pay a fine to opt out of taking it from an insurance company?
One or both of these scenarios probably applies: you are young and healthy, so your purchase is necessary to spread risk over the population as a whole; or you're underestimating the odds of getting a major disease and the cost of paying out-of-pocket.
I'm not saying we shouldn't work to lower health care costs. What I'm saying is that insurance companies pay less than cash customers for health care and they spend a lot of time checking their risk calculations. Over the long term, over the population as a whole, you can't win that game.
Let's work to lower costs and fix that, but realistically, right now, in America, it's not a game you want to play.
I think what we need for people who don't want insurance is some way to "opt out" of the health care insurance system - maybe a special card you carry that indicates to the emergency room or hospital (where maybe you have been admitted, unconscious and close to death from a car accident) that indicates any medical assistance provided will be 100% your responsibility - i.e. bill me or whatever. The only problem is that someone could then just claim bankruptcy and push the burden back onto the insured - so we'd need to make it so bankruptcy could not remove that outstanding debt.
I think what we need for people who don't want insurance is some way to "opt out" of the health care insurance system - maybe a special card you carry that indicates to the emergency room or hospital (where maybe you have been admitted, unconscious and close to death from a car accident) that indicates any medical assistance provided will be 100% your responsibility - i.e. bill me or whatever.
Why do I need to carry a card? What purpose does the card hold other than to tell the medical provider to treat me differently (as if I could either not pay (unfair to me, how do they know my assets) or could pay for better treatment (unfair to everyone else, why are some suffering through mere insurance while I have the good stuff that daddy greenbacks bring))? If you are differentiating for those without insurance, you surely must do the same for those with the comically legal 60/40 plans that have no practical out of pocket cap. 40% of a 100k bill is practically the same as being uninsured when looking at the effect of causing a bankruptcy to most of the country.
The only problem is that someone could then just claim bankruptcy and push the burden back onto the insured - so we'd need to make it so bankruptcy could not remove that outstanding debt.
Would you prevent people who signed up for 60/40 co-insurance from Aetna or Blue Cross to file for bankruptcy when they cannot afford to pay their 40%? If not, why? They choose* to not pay for better plans that limit their out of pocket liability.
Making bankruptcy harder isn't the right solution. Complete nationalization is only solution that doesn't leave uninsured and underinsured individuals who need to take a bankruptcy after an illness or accident. If that is truly the goal, then that is what should be worked at.
I don't disagree with you - I just believe there must be some way for someone to "opt out" if they want - but if they do that how do we prevent someone from gaming the system who doesn't have the money to actually pay for what they need? It's not that far fetched to be in a situation where medical expenses can be in the hundreds of thousands or even millions of dollars. Ultimately we need Medicare for everyone, but until that time (if it ever comes) is it possible to make the current law more palatable for everyone?
It has cancelled the insurance of more millions. You're not just required to have insurance, you're required to have insurance meeting higher standards than many can afford and/or were living just fine without (ex.: not paying for birth control coverage when there is absolutely zero chance of pregnancy).
>not paying for birth control coverage when there is absolutely zero chance of pregnancy
The argument here is....
It is in our best interest as a society as a whole to have a society that controls its fertility. We have less children born that aren't wanted, less teen pregnancy. Les children in hardship. That's a plus for society.
It is also beneficial to society to have children who are born healthy. That's why we are all required to pay for maternity care.
It is also beneficial to society to have a well educated populace, that's why we are all required to pay for primary education (through property taxes) even if we have no children, and can't have children.
Educating the women in society and giving them access to birth control is one of the best ways to pull a society out of poverty.
It also gave a lot of us the ability to get insurance. Pre-existing conditions prevented an awful lot of people from getting insurance or changing jobs. This fixes that huge hole. No one is saying it's perfect, but it's going in the right direction.
That's my biggest problem with the ACA, actually. I think it's great that insurance providers now have to accept pre-existing conditions, and while I'm against the ACA in general, I see that as the biggest good that it's doing.
My dislike for it is that one provision could have been its own separate law that would have been passed easily, with more bipartisan support, and would have fixed much of what ails the system. We could quibble all day over whether or not the ACA is the best way to get there (and I think very few would suggest that it is), but there are parts of it that I would support in isolation that didn't require the individual mandate, which I believe wholly violates the Constitution, regardless of what Justice Kennedy maintains.
> That's my biggest problem with the ACA, actually. I think it's great that insurance providers now have to accept pre-existing conditions, and while I'm against the ACA in general, I see that as the biggest good that it's doing
> My dislike for it is that one provision could have been its own separate law that would have been passed easily, with more bipartisan support, and would have fixed much of what ails the system
No, it would have destroyed the system.
This happened in Washington state in 1994. They passed a law in 1993 that required acceptance of people with pre-existing conditions, prevented charging sick subscribers more, and had an individual mandate to get health insurance. The mandate would start in a few years.
In 1994, Republicans got control of the state legislature, and repealed the individual mandate part of the law.
The result: people dropped insurance until they got sick, then got insurance. If their condition was not chronic, they would drop insurance after they got treatment. Insurance companies started bleeding money.
By 1998, 17 insurance companies that had provided individual health insurance in Washington no longer did so. By 1999, the last two companies that provided individual health insurance in the state stopped. You could essentially no longer buy individual health insurance in Washington.
In 2000, they modified the law so that people with pre-existing conditions had to wait nine months before insurance would be effective. I'm not sure why they picked nine months, but my guess is that it has something to do with how long pregnancy lasts in humans, because people buying insurance when they found out they were pregnant and dropping it when they brought the baby home was one of the biggest causes of losses to the insurance companies.
There's a triad of things that must be done together to make one of these "no preexisting conditions", cover everyone grand schemes work:
Guaranteed issue are the words of art for not considering preexisting conditions.
Community rating (https://en.wikipedia.org/wiki/Community_rating), means charging everyone the same amount, although that's often "Adjusted"; for Obamacare, by smoking, and maybe somewhat by age.
Individual Mandate: everyone must be part of the system.
It's the latter two that are politically difficult. Community rating means the healthy young ("young invincibles" is the current phrase) must pay a lot more to cover the less healthy older folk, also men must pay more to cover women. And it's not hidden in taxes like a single payer system.
The mandate of course means you can't escape the game for the sorts of reasons you've noted. And it's political poison, e.g. presidential candidate Obama, unlike Hillary!, was against individual mandates. And as you've noted, it's relatively easy to zap and in due course kill the rest of such a system.
Three guesses what's going to happen in 3 years when the mandate ramps up....
Ah, another critical line of attack: "BAILOUTS FOR INSURERS!!!", the "risk corridors" that will prevent them from going under this year, and the next one or two, due to insufficient signups and more importantly payments.
"Official" enrollment figures for Healthcare.gov were those who've put a plan in their cart, as of a while ago not even those who then hit "sign me up", and the communications between it and insurers are horrible, and I doubt the government even knows who's "signed up" but never paid, or stopped paying, or didn't pay their first huge bill that started to satisfy the huge deductibles of lower grade plans.
The Slate Political podcast last week (which included guest panelist Megan McArdle, who is no fan of the ACA) went into decent detail on the meaning of the signup statistics we have for ACA right now, including percentages of young signups and the "conversion" of site viewers to paying customers, and my understanding is that you've drastically oversimplified the situation w/r/t "official enrollment figures".
There will be attrition over the next several months, but I don't think it's accurate to say the official figures refer simply to people who "put a plan in their cart".
Thank you for that insight. Yet another unintended consequence I hadn't considered.
I'm eager to see how many young, healthy people are signing up for health care under ACA, because if the registrations are primarily from sick people, the system can't work, right.. or at least, not without further raising rates for those who can afford it?
There's a appalling lack of transparency in all this, but when the curtain is occasionally lifted (generally at a state site), or we otherwise hear stuff, there's nothing that indicates "young invincibles" are signing up in significant, let alone sufficient, numbers.
That may change as they get dinged for every higher penalties, but the political sustainability of those is highly questionable.
I agree that the ACA needs work, and has some questionable elements. The conflict I have is that I see as so much better than the previous non-system that it's hard to argue about it's crappy parts without someone jumping on the NObama train and killing any chance of discourse.
The position I've maintained since before its enaction is that at best, the ACA is a temporary measure. This is just my theory, and it's very possibly wrong outright.
There are a variety of problems with medical coverage in the United States, in large part, because most of our medical coverage is handled by insurance. Insurance, at its core, is not good at complete coverage, and if we expect it to be, it's always going to be more and more expensive, especially as the payer is abstracted away from the true cost.
Medical insurance arose as a response to the wage freezes enacted by the government during the war. Wages were frozen to 'stabilize' the economy and money could be dedicated to fighting the war. The unintended consequence here was that businesses, leveraging 'benefits' to compete for top talent, petitioned the IRS to allow for medical coverage to be pre-taxable income. The result is that we have a system where largely, other people are footing the bill for medical costs. This was, IMO, the genesis of our failing health care system.
This got worse and worse and worse until the ACA. Now, the ACA appears to be fixing the problem with more of the same. More people abstracted further away from the actual cost of health care.
(Again, IMO) this is not a long-term fix, and I'll be very surprised if we don't see rates escalating dramatically in the next few years.
Before insurance became pervasive, insurance was for catastrophic purposes. E.g., cancer. For general health care needs, the flu, a cold, a pulled muscle, a broken wrist, etc., people should be paying for their medical expenses out of pocket, while paying into their insurance to buffer against bankruptcy from something like cancer, leukemia, etc.
If that were the case, we'd see the free market work. People wouldn't get three X-rays and two MRIs to determine whether or not a wrist had a very minor fracture or a very major sprain -- they'd just slap a cast on it and wait a few weeks until it was better. That cast costs a small fraction of the cost of an X-ray, or an MRI... but because the insured don't generally pay those costs out of pocket, they get all the X-rays that are needed, because they're free -- and then they're surprised at the cost of health care.
I have objections to the ACA on grounds of politics, and I have concerns with the ACA on grounds of pragmatism. I certainly don't begrudge those who have needed insurance but didn't have it until now, but if we really want to lower the cost of routine health care coverage, I find the current approach to be the least likely way to address it, and foresee rising health care costs in the future.
Again, just an opinion (though I think it's informed), and I could be proven completely wrong in a few years.
Rand Corp. Their next study showed just 858,000 enrollees out of 7.1M were previously uninsured. Not sure yet what percentage of the difference were entirely voluntary transfer of services, but methinks most were signups due to cancellation of existing policies.
Why the limiting of proffered statistics to ages 18-64? I'd expect those outside that range are most in need of coverage, yet are curiously excluded from statistics touting progress toward the goal of "health insurance for all".
Not only that. Former arrangements when running multiple companies were deemed invalid, all employees having their healthcare through a holding company were dumped and forced to navigate the morass individually, leading to a three month lapse of coverage. Allegedly my family's healthcare restarts tomorrow. It is a little disconcerting that tomorrow is April Fool's Day.
"Cancelled insurance" has mostly meant that you would lose your current plan and be automatically enrolled in a new plan by the same insurer, not that you would be uninsured. Some people did in fact lose their insurance or face higher premiums, but that number is now considerably smaller than the amount of people who have gained insurance.
For anyone wondering, the Obama administration has already built in a system for letting people who tried to sign up in the next couple days but didn't complete an application sign up without a fine in preparation for this. I'm sure it won't handle all cases and seems odd given how strict they said the deadline would be, but just for clarity of debate I wanted that out there.
Real Response:
It's not so much a system as a "we're really not going to enforce this deadline for most people." It's not much of a system, it's more of a "we'll look the other way for some amount of time".
Snark Response:
The Obama administration built a system for buying health insurance, and here we are... Presumably this system will work better?
Except they didn't, as we usually view ecommerce sites. It sends (often erroneous) signup info to insurers, and it's between you and them to arrange payment.
Scheduled a major prolonged system outage the day before a major deadline? WTF?
Good morning, London. It is 6 am,
the fifth of November 2019 and this
is the voice of Fate. The new day
brings good news and bright
prospects from overseas, where
negotiations with New China are
moving in a positive direction.
Last night's scheduled demolition
of two deteriorating landmarks went
off without a hitch. Spokesman for the Interior ministry
said both structures were severely
damaged and judged to be a danger
to the unsuspecting public. Plans
for new landmarks are well
underway. - Prothero, _V_for_Vendetta_ (Government commentary spinning unexpected destruction as "planned".)
This is normal for any systems of this type. The online tax returns system for HMRC in the UK does the same thing every year. People need do it earlier.
Fining people for failing to properly utilize a system that has never consistently worked is asinine. I imagine it won't be long after the first fines that they are challenged in court.
The administration has said that you can avoid the penalty if you sign up by April 15th and affirm that you couldn't use the website before March 31st.
There is no legal basis for that waiver. The administration has violated its own hard-won law in all kinds of ways trying to compensate for its failure to effectively implement it.
The Administration actually does have legal authority to execute various parts of the law as they see fit. It does undermine credibility and set a bad future precedent, however.
First off, healthcare.gov is not the only way to get health insurance. Secondly, it's not even the only way to find health insurance using the ACA (you could do this in person, or via telephone).
Finally, a snowstorm is an excellent excuse for not jogging today, but a horrible excuse for never exercising.
The fine is, what, $95? So you could request a fee reduction of $0.26 per day that the system was down this year.
Fining people for failing to purchase a product is asinine. There's more precedent for requiring people to buy guns (and fining them if they don't; see Militia Act of 1792), but imagine the outrage if every able-bodied male 17-45 were required to buy an M16 and a case of ammo at their own cost (about $1000).
An M-16 costs far more than $1,000, and is not available for purchase by the average citizen. Between the 1934 National Firearms Act, which prohibits the sale of fully automatic weapons to those who do not submit themselves to an extended (months' long) background check and pay an additional $200 tax stamp, and the 1986 National Firearms Act, which make all fully automatic firearms manufactured post-1986 non-transferrable to citizens means that the fair market value of an M16 is something closer to $15,000-$20,000, and that's for a used model that's at least 25 years old.
If those acts were repealed, I agree that the suggested MSRP for an M16 would be ~$1,000-$2,000.
I don't believe you're showing you get the point (while making a lot of good tangential points). I seem to remember that government's cost for buying a M4 is something like $600 in quantity, but I forget if that was Colt's price before they lost the contract to FN like they lost the M16 contract (the Army buys the former, the Marines, who are still riflemen, the latter with its much longer barrel necessary to achieve bare minimum performance with normal military ammo).
So presumably in an arming the militia regime, our cost would be lower than the 1-2K you postulate, probably even lower due to massive quantity. With of course subsidies to help the poor ^_^.
(Beginning modified, for bmelton not surprisingly does get the point.)
Oh, I got the point, but historically, it went the other way around. It was the government's duty to provide firearms to the militia for those that didn't have them themselves.
That said, your sub-point is humorous, but overlooks that if modeled after the ACA, subsidized M16s would be available for near free, while non-subsidized M16s would be ~$4,000-$5,000, if you're in too high a tax bracket.
Healthcare isn't a product by any stretch of the imagination. We are human, we get sick, we get injured. Even the best of us. It is also morally wrong to not treat those who can't pay.
Disclaimer: I am not in support of the ACA, I don't think that it does a good or sane job of solving a problem.
Financial services are considered a product. I agree it's rather a stretch to use the term, but that's the norm for all financial services to be referred to in the industry as a "product". You pay an amount, you get a service; don't pay, don't get it.
Absolutely, but you won't die if you don't receive financial services. That's what makes healthcare very very different. It isn't simply a "product," it is a lifesaving measure.
Of course I am not confusing the two, but if you don't purchase health insurance, you can still get healthcare in some respect. If you cannot pay for it, then someone has to foot the bill.
If you are living, there is a good chance you will, at some time in your life, require healthcare past your ability to pay. Withholding care in the ER based on ability to pay or insurance status is already illegal (not to mention immoral). Requiring one to buy insurance to protect you, and everyone else, in that position isn't in the same realm of most things.
Note: I don't actually support the ACA because it is a very poor bandaid on a gushing wound with a lot of inefficiencies attached.
Note: most (if not all) States require car insurance as a requirement of owning and operating a motor vehicle. This is because operating a motor vehicle is dangerous and can potentially cause damage. There's a chance you'll cause damage beyond your ability to pay. Required insurance is to protect you and others, because a significant number of people will forgo insurance on their own.
However there is an arguably better chance of you getting sick or injured sometime in your life beyond your ability to pay than there is causing damage in a motor vehicle beyond your ability to pay.
I get the feeling that if we were in real fear of the Brits trying to reclaim the land, and an untrained militia had a chance of being useful, this might go over just fine.
We do from time to time invoke a draft, forcing men to fight for their lives using tools they do not own and do not understand because they are prohibited from owning & practicing with them in peacetime. Skills with large expensive crew-served equipment is understandably hard to come by and justify a standing army, but small arms are affordable for most (if new models were legal, M16s would cost about $700) and would better prepare prospective draftees. When (not if) the next draft occurs, we face calling up & sending men who not only couldn't own & practice with internationally standard front-line soldier's weapons (M16 or AK47) but would be severely punished if they tried, and will rely totally on the government supplying what they could have brought.
(Yes, some M16s et al are legal, but they're at least 28 years old, cost >20x what new retail price would be without prohibition, supply is extremely limited (hence the price increase), and are smothered in regulative "red tape".)
Ya know, it's kinda like making healthy youth pay into a healthcare system that they likely won't benefit from for a long time to come (if ever; most will put more in than they'll get out): giving people access to products (physical or financial) designed to save their lives in short-notice crises is arguably so important as to be compulsory.
Yeah, the former has no Constitutional or prior to the 20th Century, US historical basis, the latter has both. And for the Constitutional basis, I'm not referring to the 2nd Amendment, but per Article 1, Section 8:
"The Congress shall have Power...
To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;
To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;
