THCB

They’re Not Deadlines. They’re Opportunities …

Confusion about Affordable Care Act (ACA) deadlines is rampant. That’s because there are lots of them and they keep changing. The fact is that some of them matter a lot more than others.

In my view, the BIG deadline is:

MARCH 31, 2014: Under the ACA, all Americans must have health insurance, and this is the latest date you can acquire it if you wish to avoid paying a penalty on your 2014 income tax. Some individuals will be exempt from penalties, including, as of last week, people whose policies were canceled because their plans’ benefits did not meet new ACA standards of adequacy.

Another date that has drawn attention but, in my view, doesn’t matter as much:

JANUARY 1, 2014: This is not a deadline so much as an opportunity. It is the first day, when, if you signed up in time (now December 24 for the federal website, but a few states have later deadlines)—and paid your premium in time (at the administration’s urging, many insurers are allowing a grace period through January 10 for the federally run marketplaces and some states have also moved this date)—you could enjoy the subsidized coverage available under the ACA. But if you miss these so-called deadlines, you still have until March 31 to sign up for coverage to avoid a penalty.

For the millions of Americans who are uninsured, or who could have enrolled in improved insurance through a state or federal exchange, missing these deadlines merely means you failed to make yourself better off as soon as you possibly could. BUT YOU WILL BE NO WORSE OFF THAN YOU WERE BEFORE.

There are also some dates that are consequential, but have received less attention, or have receded from the headlines:

NOVEMBER 2014: This is when the Obama administration promises online enrollment for the Small Business Health Options Program (SHOP) in the 34 states where the federal government is operating the small-business marketplaces for companies with fewer than 50 workers. For now, small businesses in these states can apply via paper application or an insurance broker or navigator.

Online access is available already in most of the 17 states and the District of Columbia that are operating their own SHOP exchanges.

JANUARY 1, 2015: The date by which employers with 50 or more employees will become liable for a tax penalty if they are not offering health insurance that meets minimum standards, and an employee becomes eligible for subsidized private coverage through the marketplaces.

The changing dates associated with the ACA are troubling to some, since they suggest confusion and even mismanagement by the Obama administration. It would obviously be reassuring if every declared date were honored and announced rules and intentions never changed.

On the other hand, I’m doing some long-delayed repairs in my home. The contractor said the work would be done by Thanksgiving, but there were unanticipated problems. We’re hoping now for Christmas.  I’ll be happy if it’s done by mid-January, but the key thing is whether, a year from now, I’m satisfied with the result.

Health insurance is obviously way more important to millions of Americans than any home repair project could ever be. But few things in life go exactly as planned, and it would be totally astonishing if the implementation of massive reforms to a sector accounting for 20 percent of our economy rolled out without a bump or a detour.  We should keep that in mind as we think about those changing ACA deadlines.

David Blumenthal, M.D., M.P.P., is president of The Commonwealth Fund, where this post originally appeared.

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TheTroglodyteAliWhatsen WilliamsBobby GladdBarry Carol Recent comment authors
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TheTroglodyte
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TheTroglodyte

Healthcare is such a mess in this country. Fortunately I’m in good health thanks to websites like The Health Care Blog and http://itestosterone.com/

Ali
Guest

All the men over 40 should just go here and stop whining about nonsense like this!

Whatsen Williams
Guest
Whatsen Williams

@gladd is a shill for the HIT vendors. Obama care will fail as a greater percentage of the GNP will go to health care. Gee, are they excluding the costs EHRs from the health care column? If so, the updated percentages will be false.

Bobby Gladd
Guest
Bobby Gladd

You could not be more wrong about me. But, then, given your clueless bleatings here in general, that’s no surprise.

I AM a vendor: http://ClinicMonkey.blogspot.com

Whatsen Williams
Guest
Whatsen Williams

The savings they project from the HIT nirvanna will never materialize. Thus, the financial foundation for the ACA is cracked, and will collapse. There is a premise also that doctors will work for little or nothing paid by Obamacare insurance.

Bobby Gladd
Guest
Bobby Gladd

No one has EVER claimed that ACA success is founded on HIT. Get serious.

BC
Guest
BC

Bobby Gladd: I agree with you 100% that it would take 5-10 years to understand if ACA is a success in aggregate and it’s probably closer to 10 than 5; however, the problem is time. With ACA one is asking the populace to be guinea pigs during the time it takes to get it right. Outside of aspects of the law not working for people one also has the cost problem. It will be very difficult for many to afford the plans and you have the issue of how it hurts the rest of the economy. So the question is… Read more »

Bobby Gladd
Guest
Bobby Gladd

Good comment.

Perry
Guest
Perry

Agreed.

Bob Hertz
Guest

Aurthur, what rock are you crawling out from?

I said i did not understand the Medicare Advantage market. That is not a sin and does not disqualify me from commenting on health reform in general.

Secondly, the country decided in 1965 that persons of retirement age would have their health premiums subsidized by other taxpayers. That is because they generally have no employer and because their premiums are the highest.

We can debate the entry age, maybe 65 is too young, but are you proposing that all subsidies be stopped?

Aurthur
Guest
Aurthur

Parts of the rock (more like giant boulder) I am attempting to crawl out from include: 1) Paying a minimum 2.9% (and more) of every dollar I earn for the rest of my life as an ante into a poker game that I and my children will likely never see any potential payoff from since eventually, the game will be raided by the authorities. 2) Substantial, continued increases in income tax rates to pay towards an $80 trillion plus unfunded Medicare liability. http://www.usdebtclock.org/ 3) Having to hear from early entrants in the Medicare Ponzi scheme crow about their good fortune,… Read more »

archon41
Guest

Let’s say our 58 year old couple, like the majority of their peers, is afforded health care coverage under a plan provided by an employer. They are doubtless unhappy with the cost, to them, of that plan, and of the rising costs of medical care. Are they so unhappy, though, that they could be induced to sacrifice the quality of care they enjoy to further the “greater good” of some sort of “universal single payer” scheme? To give up their provider preferences? Do you suppose they have not heard the tales coming from Canada and the UK about the long… Read more »

Perry
Guest
Perry

Yes, the big question is what will be most important to Americans going forward; affordability? quality? choice? accessability? What would come with a single payer system?

archon41
Guest

Making a judicious determination of what is “for the good of the nation” is a most agreeable exercise. Finding a majority to support it, though, well. . . .

Bob Hertz
Guest

Note to Archon: You are a good contributor but I still disagree with you. Before the ACA, a Blue Cross policy in MN for a 60 year old and a $5,000 deductible still cost $500 a month. And this was without the ACA mandates. The market is just crappy in those areas, before and after the ACA, in my opinion. Note to Barry: I am not so sure that even $100 billion a year for the 55-64 year olds is unaffordable today. Depends how many are in the program. If 15 million baby boomers go into Medicare, and they pay… Read more »

Aurthur
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Aurthur

” I do not understand this market, but I”… I like pissing in the ocean. Not understanding has not stopped you from “educating” other folks that do understand. Here’s an idea. Why don’t you send another $1,000 a month to the feds to help pay for the rest of your share of the cost of Medicare.

Barry Carol
Guest
Barry Carol

Bob – There are very reasonably priced Medicare Advantage plans in the county where I live as well. The tradeoff, of course, is that you have to accept a limited provider network. For those of us with significant health issues, including myself, we’re better off with standard Medicare because it ensures maximum choice of doctors and hospitals. In my case, my wife and I are also subject to the maximum IRMAA surcharge which we would owe whether we chose standard Medicare or an MA plan. Between that surcharge, the standard Part B premium, our supplemental premium and the cost of… Read more »

Barry Carol
Guest
Barry Carol

Bob —

One other disadvantage of MA plans is that if you ever want to go back to standard Medicare, you can’t buy a supplemental plan unless you can pass medical underwriting. There is no underwriting requirement if you sign up for standard Medicare when you first become eligible and buy the supplemental plan then.

MD as HELL
Guest
MD as HELL

Probably there is no market to understand unless you are a politician. Medicare beneficiaries would not appreciate the notion they are on the dole. They think they earned it.

Barry Carol
Guest
Barry Carol

Bob – Since the 55-64 age group are all part of the baby boomer generation, there were approximately 40 million births in that cohort. Probably 15% of them have died by now which still leaves 34 million. I don’t think employers would selectively be able to dump those still working into Medicare but they probably could and would once they retired. However, the employer could decline to cover spouses as many do especially smaller employers. The actuarial value of Medicare breaks down roughly into $5,500 for Part A, $5,000 for Part B and $1,500 for Part D. Part B has… Read more »

Bob Hertz
Guest

I would not expect the 55 year olds to have to pay full freight to buy into Medicare. They would subsidized by overall tax revenues in the same way that Part B of Medicare is subsidized today. Just for fun (well, fun for healthcare students), let’s say that anyone over 55 with no employer coverage could buy into Medicare for 10% of their income. Say that this opened up Medicare to 5 million persons ages 55-65. They each made $30,000 a year on average and thus contributed $3,000 a year. Their actual costs in Medicare might be $9,000 a year… Read more »

Barry Carol
Guest
Barry Carol

Bob – One of the problems with trying to get / force people, even young people, to buy health insurance for the first time or buy significantly better and more comprehensive coverage than they had before is that it is so disruptive to their budgets even with subsidies in many cases. The problem is especially acute for the over 55 crowd with rules that allow 3 to 1 age rating. With pure community rating, though, insurance would be ludicrously expensive for young people. Most people, including myself, are not aware of how low the taxes were that originally financed social… Read more »

Bob Hertz
Guest

Note to Archon: Having sold health insurance in MN, I would say that the situation described for a California couple is about the same after the ACA as it was before the ACA. The individual market has long been a very expensive place for persons over 55 without employer assistance. Since the subsidies run out over about $62000 in income for a couple, and since age rating is still present albeit moderated, and since insurers still have to cover cancer and heart disease……..then costs are still very high for this group. Private insurance does not work well for everyone. At… Read more »

archon41
Guest

No, it was not the same, because prior to the ACA, our couple could have purchased a policy of their choice, instead of one loaded with benefits mandated by the Progressive Elite.

You speak much of increased taxation. Too much.

archon41
Guest

“Covered California’s shop and compare tool shows that a 58-year-old couple in Los Angeles County with $65,000 in income buying a bronze plan would have to spend $19,400, including $9,400 in premiums and a $10,000 deductible [before deductible is exhausted and ObamaCare’s benefits kick in.] (ObamaCare: Older Workers Could Pay 25% of Income, Investor’s Business Daily, 12-26-13.)

Joel Hassman, MD
Guest
Joel Hassman, MD

I get a sense the blog authors here do not like links in the comments, but after reading this tonight, it only adds to my sincere disgust with the agenda by the Democraps behind it.

The link is from Hot Air, but motivated by a story at USA Today about even more hidden fees:

http://hotair.com/archives/2013/12/26/coming-up-next-obamacare-taxes-and-fees/

I hope the blog authors allow the link, I think it applicable to the post and thread here. Really, this wonderful law and man behind it, helping the middle class exactly how, what , becoming extinct!?

Barry Carol
Guest
Barry Carol

One factor not discussed here so far is what happens to healthcare costs. Healthcare costs have come in below initial estimates for four straight years now. In fiscal 2013, per capita Medicare spending was flat vs. 2012 resulting in no increase in Part B premiums for 2014. Nobody understands exactly what is driving this but getting ready for the ACA is probably part of it. Hospitals, for example, are focusing more aggressively on reducing hospital acquired infections and preventable readmissions. In the private sector, we are likely to see explosive growth over the next several years in private exchanges, especially… Read more »