What to Expect in the Government Controlled Health System, Part 1

Unless Congress makes major changes by 2014, we will face The Affordable Care Act.   Many American consumers are unhappy with some aspects of government-run health care and pundits rant on its failings and merits.  Consumers deserve a lucid presentation of the choices and costs that they will face directly, and in “Part 1” (of this blog) that is shown.  Separately, it is important to understand the government intentions to alter health treatment delivery and handle costs.  That will be covered in “Part 2.”   

 

The Affordable care Act carves the population into income and age strata.   For low-income people under age 65, Medicaid is the plan.  For those aged 65 or older, Medicare is the plan.   For those eligible, it’s their employer’s health plan.  Those ineligible for an employer plan must choose from a “Health Exchange” plan, of which there is supposed to be at least two options.  If you choose “no plan” you are fined.

 

Your Eligibility

If Your Annual Income is

     
 

Single

Family

     

Medicaid for under age 65

 up to $14,404

 up to $29,327

     

Medicare for 65 or older

  

 

     
           
 

If Your Annual Income is

     

Pick a Health Exchange Plan

Single

Family

     

with Premium Subsidy

up to $43,320

up to $88,200

Subsidy cuts premium to 2 – 9.5% of income

without Premium Subsidy

above $43,320

above $88,200

You pay the full Premium

 

with Cost Sharing Subsidy

up to $27,075

up to $55,125

Uncertain Subsidy for co-pays & deductibles

without Cost Sharing Subsidy

above $27,075

above $55,125

You pay all co-pays & deductibles

           
 

Single

Family

     

If You choose “No Plan”

fine of $695

fine of $2085

or up to $2.5% of family income

 
           

If eligible for an employer’s health plan but you do not enroll, you are automatically enrolled in plan with the lowest premium        

     
       

 

In the “Pick a Health Exchange Plan” block above, the government subsidy intent is shown.  But unknown are the premiums, co-pays and deductibles for the plans that will be available in 2014.  In each Health Exchange, there will be at least 2 multi-state health plans (probably HMO or PPO) and likely one or more health co-ops, since Federal funding is offered to co-ops.  Each plan must cover everything the Federal government demands without excluding pre-existing conditions, or imposing limits on lifetime payouts.  The rich coverage suggests an Exchange plan will cost more than 2010’s typical $4,300 family premium and $2,500 in out of pocket costs.   Seven percent inflation would lead to $5,600 and $4,300 in 2014, i.e. about $10,000.  The Affordable Care authors think they can contain costs using tactics we’ll show in “Part 2.” 

 

Alan Daley is a retired businessman living in Florida.  He follows public policy from the consumer’s perspective.

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