Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

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Ron Ronnerson
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by Ron Ronnerson »

curmudgeon wrote: Sat Dec 15, 2018 11:14 am My actionable question is whether I should try to switch my 2019 ACA application to using the advance premium tax credits. For the past two years, I've been paying the full premiums out of pocket and collecting the subsidy in my tax return. Partly because the California site was so screwed up, and partly because paying the premiums by credit card was an easy way to meet the spending requirements for CC signup bonuses. I'd hate to do that again this year and then have some technicality from the end ruling come up and find that I'm not able to get the refundable tax credit when I file 2019 taxes.
While you’re probably going to be fine either way, I personally prefer cash in hand as early as possible. I agree that the Covered CA site is less than perfect. 2019 will be the first year we qualify for the premium tax credit (my wife stopped working this year and our income is lower now). An agent was very helpful in setting us up on Covered CA. He helped submit documentation that was requested and navigating the unclear questions that came up on the application. We dealt with the agent over the phone only and there was no cost to us.

We are into credit card bonuses as well so I understand the perk of easily meeting minimum spending requirements. However, it’s nice to have small insurance payments each month for cash flow purposes and you can also earn some interest on the money you have in the bank rather than going toward premiums (a small silver lining). We do pay property taxes on credit cards. Even after the fee for paying with a credit card, it’s worthwhile with some of the bonus offers out there.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by vested1 »

It has been pointed out on several other sites that I frequent that this decision could have unforeseen consequences. Judge O'Conner, the federal judge who issued this decision, said that the issue of the zeroing out of the mandate penalty was unconstitutional, and because of that, the entire ACA law was unconstitutional. His reasoning was that the mandate provision and the entire ACA bill were inseparable. In the same way, if upheld, the entire tax cut bill could also be deemed to be unconstitutional because the elimination of the mandate penalty was a central part of that bill.
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by yohac »

munemaker wrote: Sat Dec 15, 2018 11:25 am If you are responsible and are continuously covered by health insurance, as you should be, what is the concern about preexisting conditions? Can someone please explain?
We're mixing HIPAA and ACA. With HIPAA and employer coverage, pre-existing conditions must be covered if the employee had continuous coverage prior to employment. The employer however can have a waiting period of up to 90 days. The pre-existing conditions danger in this ruling applies to individual policies.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by willthrill81 »

BrooklynInvest wrote: Sat Dec 15, 2018 11:39 amI'm hopeful this gets resolved without change. Else my early retirement is in jeopardy. Moving to England our backup plan.
Health sharing plans may be an option. If we were to retire now, we'd very likely go that route in lieu of traditional insurance. Truth be told, if I had my druthers, it would be for one of the old-school major medical policies that didn't cover trips to your regular physician's office for a sniffle.

I suspect that if the ACA doesn't survive that the health sharing plans may get a lot of new applicants.
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by jpelder »

quantAndHold wrote: Sat Dec 15, 2018 10:51 am
MinhN wrote: Sat Dec 15, 2018 10:31 am
quantAndHold wrote: Sat Dec 15, 2018 10:05 am
MinhN wrote: Sat Dec 15, 2018 9:01 am New Jersey made it mandatory to carry health insurance or face a penalty so nothing changes for me as a resident.
If this ruling stands, you might not be able to actually get that required health insurance.
I don't see how this ruling would strike down the NJ law. People can buy health insurance outside of the marketplace.
The part of the law that’s in question at the moment is that insurance companies are required to sell insurance to everyone for the same basic price, regardless of preexisting conditions. Before the ACA, the price of insurance rose dramatically with age, and if you had any preexisting condition at all, you couldn’t get insurance at any price. People not being able to get health insurance was a normal problem. We would be going back to that. You might be required by your state to have insurance, but you you might not be able to actually get it.
I don't see how the pre-existing condition provision would be unconstitutional, since Congress has explicit, ennumerated power to regulate interstate commerce, which insurance clearly is.

That said, nothing will change for 2019, since the ruling is stayed and will surely be appealed all the way up to the Supreme Court, who would not hear it until the 2020 term (since it would have to work through the Appeals Courts first). And, if I'm not mistaken, the insurance policies are yearly contracts which couldn't be cancelled mid-year, even if the law changes.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by willthrill81 »

vested1 wrote: Sat Dec 15, 2018 11:54 amIn the same way, if upheld, the entire tax cut bill could also be deemed to be unconstitutional because the elimination of the mandate penalty was a central part of that bill.
A law won't be ruled as unconstitutional just because it conflicts with an existing law. In this case, the ACA is not part of the U.S. constitution, so a law that is ruled by the courts to nullify the ACA wouldn't be called unconstitutional just because of the nullification.

The problem of conflicting laws is not a new one, and if the legislature doesn't address the problem, the courts will be forced to sort it out.
Conflict of laws in the United States is the field of procedural law dealing with choice of law rules when a legal action implicates the substantive laws of more than one jurisdiction and a court must determine which law is most appropriate to resolve the action. In the United States, the rules governing these matters have diverged from the traditional rules applied internationally. The outcome of this process may require a court in one jurisdiction to apply the law of a different jurisdiction.
https://en.wikipedia.org/wiki/Conflict_ ... ted_States
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by visualguy »

BrooklynInvest wrote: Sat Dec 15, 2018 11:39 am
If you are responsible and are continuously covered by health insurance, as you should be, what is the concern about preexisting conditions? Can someone please explain?
This is a good question. My guess is that confusion would ensue as this gets answered. . . perhaps 50 times.

But plans are renewed annually so I believe there's a significant risk that your insurance wouldn't be renewed OR your insurer would go back to being able to discriminate through price -

"Sure we'll offer you insurance now that you have ______, but your premiums are gonna go up by X hundred percent."

I'm hopeful this gets resolved without change. Else my early retirement is in jeopardy. Moving to England our backup plan.
Right. Another thing they used to do before the ACA is have clauses about being able to deny coverage if you don't declare all your pre-existing conditions. When you got seriously sick, they would dig up some old condition in your medical records. It could be minor and unrelated, such as acne, but it would be enough for them to use the clause that enables them to deny coverage.

Since I have pre-existing conditions, I would need to keep working as long as possible for two reasons. One is to have group insurance to enable me to be insured, and at a cost that isn't totally insane. The other reason is to be able to save more money in case I lose my job and the group insurance due to illness or some other reason.
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by cas »

munemaker wrote: Sat Dec 15, 2018 11:25 am
quantAndHold wrote: Sat Dec 15, 2018 10:51 am ... if you had any preexisting condition at all, you couldn’t get insurance at any price.
If you are responsible and are continuously covered by health insurance, as you should be, what is the concern about preexisting conditions? Can someone please explain?
You may be interested in the "Non-Group Insurance Market Practices Before the ACA" section of this issue brief from Kaiser Family Foundation.

"Pre-ACA Market Practices Provide Lessons for ACA Replacement Approaches", February 2017, Kaiser Family Foundation, https://www.kff.org/health-costs/issue- ... pproaches/ (scroll down to the "Non-Group Insurance Market Practices Before the ACA" section)

That article mentions "closed blocks of business" (a concept which is very relevant to pre-existing conditions) briefly, but this earlier article explains it more thoroughly. This article is from 2012, and I didn't read it closely enough to see if it had aged well or badly. I just knew I had read a better description of "closed blocks" somewhere on KFF, and this seems to be it. So scroll down to the "closed blocks of business" section.

"What Do They Mean When They Talk About Pre-Existing Health Conditions?" Oct 2012, Kaiser Family Foundation.
https://www.kff.org/health-reform/persp ... onditions/
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by vested1 »

willthrill81 wrote: Sat Dec 15, 2018 12:17 pm
vested1 wrote: Sat Dec 15, 2018 11:54 amIn the same way, if upheld, the entire tax cut bill could also be deemed to be unconstitutional because the elimination of the mandate penalty was a central part of that bill.
A law won't be ruled as unconstitutional just because it conflicts with an existing law. In this case, the ACA is not part of the U.S. constitution, so a law that is ruled by the courts to nullify the ACA wouldn't be called unconstitutional just because of the nullification.

The problem of conflicting laws is not a new one, and if the legislature doesn't address the problem, the courts will be forced to sort it out.
Conflict of laws in the United States is the field of procedural law dealing with choice of law rules when a legal action implicates the substantive laws of more than one jurisdiction and a court must determine which law is most appropriate to resolve the action. In the United States, the rules governing these matters have diverged from the traditional rules applied internationally. The outcome of this process may require a court in one jurisdiction to apply the law of a different jurisdiction.
https://en.wikipedia.org/wiki/Conflict_ ... ted_States
Nor is the recent tax cut part of the U.S. constitution. You miss my point. Once we start declaring all or nothing on existing laws and use that as a justification for declaring the entire law unconstitutional we enter a minefield. This is part of why some are saying the decision is on shaky ground.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by willthrill81 »

vested1 wrote: Sat Dec 15, 2018 1:04 pm
willthrill81 wrote: Sat Dec 15, 2018 12:17 pm
vested1 wrote: Sat Dec 15, 2018 11:54 amIn the same way, if upheld, the entire tax cut bill could also be deemed to be unconstitutional because the elimination of the mandate penalty was a central part of that bill.
A law won't be ruled as unconstitutional just because it conflicts with an existing law. In this case, the ACA is not part of the U.S. constitution, so a law that is ruled by the courts to nullify the ACA wouldn't be called unconstitutional just because of the nullification.

The problem of conflicting laws is not a new one, and if the legislature doesn't address the problem, the courts will be forced to sort it out.
Conflict of laws in the United States is the field of procedural law dealing with choice of law rules when a legal action implicates the substantive laws of more than one jurisdiction and a court must determine which law is most appropriate to resolve the action. In the United States, the rules governing these matters have diverged from the traditional rules applied internationally. The outcome of this process may require a court in one jurisdiction to apply the law of a different jurisdiction.
https://en.wikipedia.org/wiki/Conflict_ ... ted_States
Nor is the recent tax cut part of the U.S. constitution. You miss my point. Once we start declaring all or nothing on existing laws and use that as a justification for declaring the entire law unconstitutional we enter a minefield. This is part of why some are saying the decision is on shaky ground.
Again, since neither law is part of the constitution, them conflicting with one another is not an issue of constitutionality.

The 'all or nothing' you refer to in this instance was because the 'heart' of the ACA that made it legal was arguably ripped out by the TCJA. Without the individual mandate and the associated tax for failure to comply, the judge ruled the ACA as a whole as being unconstitutional because the needed legal foundation for its existence is no longer there. Frankly, I don't see this as necessarily being a legal minefield. Laws have been nullified by later laws many times, whether by legislatures or courts. If the ruling stands, Congress will very likely get involved to sort it out, and if they can't or don't, the courts will. That being said, I will grant you that there is a lot of uncertainty around the future of the issue.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by p14175 »

The preexisting health issues is a big deal for me. My health has been great (except for mild arthritis) so I have been cash pay for several years. Then all of a sudden I get a cancer diagnosis. My DH and I make too much in retirement income by just a few dollars to qualify for hardship grants and government assistance programs. My cancer doesn't qualify for SS Disability. I am not old enough (59 yo) for SSI or Medicare. I have been able to get deep discounts for a lot of the visits, tests, scans, surgery, and hospital stays, but cancer is very expensive and it has to be watched for several years or maybe for the rest of my life. I can tell you that the medical industry would prefer not dealing with cash pay even if it simplifies their accounting.

I reluctantly signed up for health insurance through the ACA Marketplace for 2019, but there's a catch. In order to keep the subsidy our income can't change much. So I can't work (who is going to hire someone with preexisting health issues?) or get my software startup going -- something I have been working on the last 2 years. If I use IRA money to help cover costs, it will make our income increase to a point where I will have to start paying the subsidy back or cancel the insurance. In other words, purchase health insurance via ACA Marketplace and you are pretty much locked into a system that is very similar to traditional government welfare programs.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by A-Commoner »

Is this ruling good or bad for health insurance stocks? What about the health care sector in general? If I’m not mistaken, Obamacare was surprisingly good for health care sector and health insurance stocks, despite initial fears to the contrary.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

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A-Commoner wrote: Sat Dec 15, 2018 1:45 pm Is this ruling good or bad for health insurance stocks?
Yes. :D
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by munemaker »

yohac wrote: Sat Dec 15, 2018 12:05 pm
munemaker wrote: Sat Dec 15, 2018 11:25 am If you are responsible and are continuously covered by health insurance, as you should be, what is the concern about preexisting conditions? Can someone please explain?
We're mixing HIPAA and ACA. With HIPAA and employer coverage, pre-existing conditions must be covered if the employee had continuous coverage prior to employment. The employer however can have a waiting period of up to 90 days. The pre-existing conditions danger in this ruling applies to individual policies.
Thank you Yohac. That's what I was thinking of.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by JoMoney »

willthrill81 wrote: Sat Dec 15, 2018 2:02 pm
A-Commoner wrote: Sat Dec 15, 2018 1:45 pm Is this ruling good or bad for health insurance stocks?
Yes. :D
Accurate. :D

My guess, is it doesn't mean anything at this point, it is being contested, and won't impact the coming year. It does raise a lot of uncertainty about the future though, and uncertainty typically is bad for stocks. I would expect it will force the legislature to act, one way or another, and whatever new changes come out will have an impact on the insurance business but who knows what that will be...
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by FoolMeOnce »

vested1 wrote: Sat Dec 15, 2018 1:04 pm
willthrill81 wrote: Sat Dec 15, 2018 12:17 pm
vested1 wrote: Sat Dec 15, 2018 11:54 amIn the same way, if upheld, the entire tax cut bill could also be deemed to be unconstitutional because the elimination of the mandate penalty was a central part of that bill.
A law won't be ruled as unconstitutional just because it conflicts with an existing law. In this case, the ACA is not part of the U.S. constitution, so a law that is ruled by the courts to nullify the ACA wouldn't be called unconstitutional just because of the nullification.

The problem of conflicting laws is not a new one, and if the legislature doesn't address the problem, the courts will be forced to sort it out.
Conflict of laws in the United States is the field of procedural law dealing with choice of law rules when a legal action implicates the substantive laws of more than one jurisdiction and a court must determine which law is most appropriate to resolve the action. In the United States, the rules governing these matters have diverged from the traditional rules applied internationally. The outcome of this process may require a court in one jurisdiction to apply the law of a different jurisdiction.
https://en.wikipedia.org/wiki/Conflict_ ... ted_States
Nor is the recent tax cut part of the U.S. constitution. You miss my point. Once we start declaring all or nothing on existing laws and use that as a justification for declaring the entire law unconstitutional we enter a minefield. This is part of why some are saying the decision is on shaky ground.
Scholars are saying that the severability analysis is shaky, yes. But that does not indicate the tax act is also unconstitutional.

The ruling held that:

1) the tax for non-compliance with the mandate is what made the mandate constitutional under congress's taxation power, according to the USSC;

2) with the tax reduced to zero, the mandate can no longer be considered an exercise of congress's power to tax and is unconstitutional;

3) the mandate cannot be severed from the rest of the ACA's previsions, even if those are perfectly constitutional, because congress intended them to work together and would not want the other provisions without the mandate (despite congress effectively neutering the mandate while leaving the rest of the provisions intact - hence many scholars' surprised response),

4) therefore, the entire ACA must be stricken.

Nothing in this analysis could be used to say the tax bill must fall. Congress properly used its power to reduce the mandate tax to zero. That triggered effects on the ACA, but no rebounding effects on the tax bill.

As to the question by another poster, yes, congress can pass the same pre-existing conditions regulations. This decision did not say that anything other than the individual mandate ciliated the constitution.
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by vitaflo »

quantAndHold wrote: Sat Dec 15, 2018 11:00 am
Hayden wrote: Sat Dec 15, 2018 10:40 am
quantAndHold wrote: Sat Dec 15, 2018 10:00 am Keeping it to my situation. I would be affected.

Plan A would be to hope my state legislature steps in and does something. Since I live in California, that seems like a plausible thing to hope for.

Plan B would be to go back to work. I’m only a couple of years away from working, and I still get contacts from recruiters. I can do contract work 3-6 months per year, then use COBRA until it runs out. Then get another contract. I don’t want to work, work was destroying my health, and have no financial need other than for healthcare purposes, but there you are.

Plan C would be to move to Massachusetts.
How does contract work get you health insurance? The companies I am familiar with do not provide health insurance to contractors, particularly those working 3-6 months per year.

I'm in a similar situation, and am actually considering moving to California.
I work in software development. All the contract jobs now are W-2 employment with a job shop that pays “full” benefits, including health insurance that’s eligible for COBRA. A 401K kicks in once you’re there for six months.

I was looking for 1099 contracts last year, because I wanted to put the income into a 401K, but didn’t want to work all year. All I could find was W-2.
Entirely depends on where you live. Where I live, all software dev contracts are 1099, no benefits. Certainly if you're on the west coast, that will be different (thanks Microsoft).
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by mattsm »

Guys, if you have continuing coverage insurance could not discriminate before ACA? This includes transition from employer to retirement. It was always -very- important to maintain continuing coverage.

Am I missing something here? Still young and very concerned about Health Insurance as I'm self employed and already paying ridiculous amounts of money for this.

-M
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by willthrill81 »

FoolMeOnce wrote: Sat Dec 15, 2018 2:20 pm
vested1 wrote: Sat Dec 15, 2018 1:04 pm
willthrill81 wrote: Sat Dec 15, 2018 12:17 pm
vested1 wrote: Sat Dec 15, 2018 11:54 amIn the same way, if upheld, the entire tax cut bill could also be deemed to be unconstitutional because the elimination of the mandate penalty was a central part of that bill.
A law won't be ruled as unconstitutional just because it conflicts with an existing law. In this case, the ACA is not part of the U.S. constitution, so a law that is ruled by the courts to nullify the ACA wouldn't be called unconstitutional just because of the nullification.

The problem of conflicting laws is not a new one, and if the legislature doesn't address the problem, the courts will be forced to sort it out.
Conflict of laws in the United States is the field of procedural law dealing with choice of law rules when a legal action implicates the substantive laws of more than one jurisdiction and a court must determine which law is most appropriate to resolve the action. In the United States, the rules governing these matters have diverged from the traditional rules applied internationally. The outcome of this process may require a court in one jurisdiction to apply the law of a different jurisdiction.
https://en.wikipedia.org/wiki/Conflict_ ... ted_States
Nor is the recent tax cut part of the U.S. constitution. You miss my point. Once we start declaring all or nothing on existing laws and use that as a justification for declaring the entire law unconstitutional we enter a minefield. This is part of why some are saying the decision is on shaky ground.
Scholars are saying that the severability analysis is shaky, yes. But that does not indicate the tax act is also unconstitutional.

The ruling held that:

1) the tax for non-compliance with the mandate is what made the mandate constitutional under congress's taxation power, according to the USSC;

2) with the tax reduced to zero, the mandate can no longer be considered an exercise of congress's power to tax and is unconstitutional;

3) the mandate cannot be severed from the rest of the ACA's previsions, even if those are perfectly constitutional, because congress intended them to work together and would not want the other provisions without the mandate (despite congress effectively neutering the mandate while leaving the rest of the provisions intact - hence many scholars' surprised response),

4) therefore, the entire ACA must be stricken.

Nothing in this analysis could be used to say the tax bill must fall. Congress properly used its power to reduce the mandate tax to zero. That triggered effects on the ACA, but no rebounding effects on the tax bill.

As to the question by another poster, yes, congress can pass the same pre-existing conditions regulations. This decision did not say that anything other than the individual mandate ciliated the constitution.
Excellently put. :beer
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by vitaflo »

Interesting that this was ruled in Texas as Texas has the highest percentage of uninsured in the nation. In fact, Texas' percentage of uninsured right now is still higher than a vast majority of states were even before the ACA took effect. If you look at uninsured rates, Texas has always been the largest statistical outlier.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by willthrill81 »

vitaflo wrote: Sat Dec 15, 2018 2:51 pm Interesting that this was ruled in Texas as Texas has the highest percentage of uninsured in the nation. In fact, Texas' percentage of uninsured right now is still higher than a vast majority of states were even before the ACA took effect. If you look at uninsured rates, Texas has always been the largest statistical outlier.
From a legal perspective, that's irrelevant. I for one am glad that this judge at least based his decision on what he believes the law says and not on the potential ramifications. The latter should be the purview of the legislature.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by LadyGeek »

The discussion is getting derailed on conjecture regarding legal perspectives of the judge's decision.

Please stay on-topic, which is how the ruling impacts your own situation.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by willthrill81 »

Trying to keep the thread on track, I wonder what the implications of this ruling, assuming it is upheld, will be in the medium- to long-term for those of us with employer-provided health insurance plans.
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by talzara »

quantAndHold wrote: Sat Dec 15, 2018 10:51 am
MinhN wrote: Sat Dec 15, 2018 10:31 am I don't see how this ruling would strike down the NJ law. People can buy health insurance outside of the marketplace.
The part of the law that’s in question at the moment is that insurance companies are required to sell insurance to everyone for the same basic price, regardless of preexisting conditions. Before the ACA, the price of insurance rose dramatically with age, and if you had any preexisting condition at all, you couldn’t get insurance at any price. People not being able to get health insurance was a normal problem. We would be going back to that. You might be required by your state to have insurance, but you you might not be able to actually get it.
That is not in question in New Jersey.

Prior to the ACA, New Jersey already had guaranteed issue, a compressed age curve, and gender neutrality. The biggest missing piece was the individual mandate, but New Jersey has enacted an individual mandate for 2019. The penalty is the same as the ACA penalty for 2018.

Unlike Romneycare, which was designed as a complete solution, New Jersey passed a patchwork of laws over several decades. New Jersey doesn't have an exchange, so it can't pay advance subsidies. It doesn't require policies to cover preventive care before the deductible. There are many other missing pieces.

However, the mandate is what makes everything else possible. It makes guaranteed issue possible by forcing healthy people to subsidize sick people. It makes gender neutrality possible by forcing unmarried males to subsidize pregnant females. It makes a compressed age curve possible by forcing young people to subsidize their grandparents.

New Jersey passed its mandate by a 2/3 majority in the Assembly, and it got almost 2/3 in the Senate. If they can pass the mandate, then they have the votes to pass all the other pieces.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by wolf359 »

I think the real question is how the uncertainty is impacting your personal situation, and what you can do about it.

Those who retire at 65 are eligible for Medicare.

Those who retire before 65 need to use employer healthcare retirement benefits (if available), use Obamacare, or use one of the compliant health sharing plans (which aren't that great for people with recurring health issues.)

If you haven't early retired, you could simply keep working while this situation clarifies.

If you have early retired years ago, and are relying on Obamacare for insurance, what are you doing to prepare in the event it fails due to recent legislative changes, or if it doesn't survive the appeal?

Is anybody holding off pulling the trigger on retirement due to this issue? Pre-retirement, the main action you can take is to save more or plan for a part-time job that maintains coverage (if you can't get it otherwise.) If your early retirement is unavoidable (such as due to a health issue), I'm not sure what options you might have.

This does make it less likely I'd consider actually pulling the trigger on early retirement. It won't stop my wife from doing so at the earliest opportunity.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by dcop »

wolf359 wrote: Sat Dec 15, 2018 4:42 pm
If you have early retired years ago, and are relying on Obamacare for insurance, what are you doing to prepare in the event it fails due to recent legislative changes, or if it doesn't survive the appeal?

If your early retirement is unavoidable (such as due to a health issue), I'm not sure what options you might have.
Considering this possibility is less than 24hrs old I doubt preparation is even logical.

As far as options for folks over 50 without employer insurance is nearly null. Short-term plans and sharing are most likely the only options. And add a pre-existing condition - it is null.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by goaties »

dcop wrote: Sat Dec 15, 2018 4:49 pm Considering this possibility is less than 24hrs old I doubt preparation is even logical.

As far as options for folks over 50 without employer insurance is nearly null. Short-term plans and sharing are most likely the only options. And add a pre-existing condition - it is null.
Actually, the possibility that Obamacare will implode has been with us from its inception as various supportive legs keep getting cut out from under it.

Preparation is possible: in order to early-retire, in addition to having significant savings, you should also have maximum flexibility for relocation. You may need to move to another state/country to get reliable access to medical care. Careful analysis now of what is available in other states or countries will help prepare the early retiree to hit the ground running, once implosion occurs.
theplayer11
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by theplayer11 »

good, hope my state goes back to a low risk pool where premiums were much lower. ACA did away with that and premiums skyrocketed.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by nisiprius »

I think this is pretty clearly a "nobody knows yet, we have to wait and see" situation. Press reports suggest that the court ruling is controversial and not at all a slam dunk. This isn't a case where the law is obvious and just hadn't been tested.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by visualguy »

theplayer11 wrote: Sat Dec 15, 2018 5:01 pm good, hope my state goes back to a low risk pool where premiums were much lower. ACA did away with that and premiums skyrocketed.
That works only until you get seriously sick, so it pretty much defeats the main reason for the insurance. Once you have to be moved from a "low-risk" pool to a "high-risk" pool you're in deep trouble because of costs and lack of availability. This concept didn't actually work in practice in the past.
cmdreset
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by cmdreset »

wolf359 wrote: Sat Dec 15, 2018 4:42 pm
Is anybody holding off pulling the trigger on retirement due to this issue? Pre-retirement, the main action you can take is to save more or plan for a part-time job that maintains coverage (if you can't get it otherwise.) If your early retirement is unavoidable (such as due to a health issue), I'm not sure what options you might have.
Yup - many of us with pre-existing conditions remember the bad old days when you couldn't get insurance at any price without being employed. If your health was bad enough (e.g. a cancer diagnosis) that you couldn't hold a job then bankruptcy was often the only option. If you were in the individual market, then even those with "continuous coverage" were given rate increases once they got sick that made said coverage essentially worthless.

So I am keeping my job for the time being until I get closer to 65...
jibantik
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by jibantik »

theplayer11 wrote: Sat Dec 15, 2018 5:01 pm good, hope my state goes back to a low risk pool where premiums were much lower. ACA did away with that and premiums skyrocketed.
Ah yes, the good ol' days when if you got sick you couldn't get or couldn't afford health insurance, but at least it was cheap for healthy people.
wolf359 wrote: Sat Dec 15, 2018 4:42 pm Is anybody holding off pulling the trigger on retirement due to this issue? Pre-retirement, the main action you can take is to save more or plan for a part-time job that maintains coverage (if you can't get it otherwise.) If your early retirement is unavoidable (such as due to a health issue), I'm not sure what options you might have.
This is why you marry a foreigner and retire in a country with universal healthcare :D

Also, in before lock.
J295
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by J295 »

We are early retirees.

Life is full speed bumps. When they occur —-accept, adjust, move forward.

Doesn’t seem appropriate to start screaming the sky is falling from a single judge ruling, subject to appeal, for which enforcement has been stayed.
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Re: ACA Struck down...yikes [by federal judge in Texas]

Post by tadamsmar »

"a U.S. government official said the decision by a Texas judge would have no immediate impact on health coverage."

https://www.nbcnews.com/news/us-news/tr ... ge-n948401

If this is true, then one should proceed in the short run as if the ruling never happened.

If you feel ( or have) a need to insure against the ACA safeguards possibly being overturned, then, if you are not going to be on Medicare soon, seek to get a job (or another arrangement) with health insurance that covers pre-existing conditions even if the ACA is overturned.
theplayer11
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by theplayer11 »

visualguy wrote: Sat Dec 15, 2018 5:23 pm
theplayer11 wrote: Sat Dec 15, 2018 5:01 pm good, hope my state goes back to a low risk pool where premiums were much lower. ACA did away with that and premiums skyrocketed.
That works only until you get seriously sick, so it pretty much defeats the main reason for the insurance. Once you have to be moved from a "low-risk" pool to a "high-risk" pool you're in deep trouble because of costs and lack of availability. This concept didn't actually work in practice in the past.
actually, there wasn't a low risk pool. It was a regular pool and a preferred pool. We also had a "decreasing deductible" where the deductible dropped every year when not reached. ACA wiped all that out and my premiums increased dramatically.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by Northern Flicker »

An opinion of a U of Michigan law professor is that this opinion of 1 judge in Wichita, TX has a very low chance of holding up. It seems that the most likely outcome may be to strike down the individual mandate for which the penalty was removed anyway. Perhaps an appeals court will change the remedy to that, and the Supreme court will not even accept the case.
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Re: Obamacare (ACA) Ruled Illegal by Texas Federal Court

Post by randomguy »

jpelder wrote: Sat Dec 15, 2018 12:13 pm

I don't see how the pre-existing condition provision would be unconstitutional, since Congress has explicit, ennumerated power to regulate interstate commerce, which insurance clearly is.

That said, nothing will change for 2019, since the ruling is stayed and will surely be appealed all the way up to the Supreme Court, who would not hear it until the 2020 term (since it would have to work through the Appeals Courts first). And, if I'm not mistaken, the insurance policies are yearly contracts which couldn't be cancelled mid-year, even if the law changes.
Most insurance is regulated at the state level. You can use the commerce clause though to justify pretty much anything. The issue will always be of how affordable your system is. If you make it too expensive the people without preexisting conditions opt out until they get a preexisting condition.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by randomguy »

mattsm wrote: Sat Dec 15, 2018 2:25 pm Guys, if you have continuing coverage insurance could not discriminate before ACA? This includes transition from employer to retirement. It was always -very- important to maintain continuing coverage.

Am I missing something here? Still young and very concerned about Health Insurance as I'm self employed and already paying ridiculous amounts of money for this.

-M
In the old days you could go from group plan to group plan as long as you had continuous coverage (HIPAA). At a high level what you couldn't do was go from a group plan to an individual plan (i.e. you wanted to retire). If you wanted to that you had to get underwritten as an individual. People used to have to work to get health insurance. Part of that was cost. A lot of it was that plans were just not available.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by Jefferson »

Action step: Research Associated Health plans.

The possibility of AHPs taking off was increased earlier this year when Trump signed an EO on them. Honestly, I’m not sure what the EO did exactly, but the intent was to identify and promote alternatives to the ACA, and AHPs were explicitly identified as such.

AHPs are essentially employer plans without the employer. The whole benefit of the employer plan (to the employee) is to be insured as part of a large pool of people. But the big (really huge) drawback of employer plans is that they are tied to your employer. AHPs allow any group to create a pool of people to purchase health insurance. Imagine the size of the pool (and the prices going down due to competition) if groups like the AARP and the NRA could offer group health insurance to its members. There could be a Bogleheads group plan!

AHPs are portable, so you would never lose coverage if you quit or lose your job.

EDIT- Yes, there are other benefits to employer plans. Assistance with paying premiums and special tax treatment of that assistance are two of them.
Last edited by Jefferson on Sat Dec 15, 2018 8:38 pm, edited 1 time in total.
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fortfun
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by fortfun »

jibantik wrote: Sat Dec 15, 2018 6:21 pm
theplayer11 wrote: Sat Dec 15, 2018 5:01 pm good, hope my state goes back to a low risk pool where premiums were much lower. ACA did away with that and premiums skyrocketed.
Ah yes, the good ol' days when if you got sick you couldn't get or couldn't afford health insurance, but at least it was cheap for healthy people.
wolf359 wrote: Sat Dec 15, 2018 4:42 pm Is anybody holding off pulling the trigger on retirement due to this issue? Pre-retirement, the main action you can take is to save more or plan for a part-time job that maintains coverage (if you can't get it otherwise.) If your early retirement is unavoidable (such as due to a health issue), I'm not sure what options you might have.
This is why you marry a foreigner and retire in a country with universal healthcare :D

Also, in before lock.
Why didn't you tell me this 23 years ago ;)
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dcop
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by dcop »

Jefferson wrote: Sat Dec 15, 2018 8:35 pm Imagine the size of the pool (and the prices going down due to competition) if groups like the AARP and the NRA could offer group health insurance to its members. There could be a Bogleheads group plan!
While I haven't read into AHP's recently when I did it was still 'employee' driven as far as it mostly applied to Small Biz banding together. I have yet hear of anything like organizations as you mentioned ever getting a pool and developing these plans. Has it ever happened?
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by marcopolo »

dcop wrote: Sat Dec 15, 2018 8:45 pm
Jefferson wrote: Sat Dec 15, 2018 8:35 pm Imagine the size of the pool (and the prices going down due to competition) if groups like the AARP and the NRA could offer group health insurance to its members. There could be a Bogleheads group plan!
While I haven't read into AHP's recently when I did it was still 'employee' driven as far as it mostly applied to Small Biz banding together. I have yet hear of anything like organizations as you mentioned ever getting a pool and developing these plans. Has it ever happened?
Years ago, the IEEE (institute of electrical and electronic engineers) used to offer a group health insurance plans to any of its members. I believe that was set up an a AHP.
Once in a while you get shown the light, in the strangest of places if you look at it right.
visualguy
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by visualguy »

theplayer11 wrote: Sat Dec 15, 2018 7:18 pm
visualguy wrote: Sat Dec 15, 2018 5:23 pm
theplayer11 wrote: Sat Dec 15, 2018 5:01 pm good, hope my state goes back to a low risk pool where premiums were much lower. ACA did away with that and premiums skyrocketed.
That works only until you get seriously sick, so it pretty much defeats the main reason for the insurance. Once you have to be moved from a "low-risk" pool to a "high-risk" pool you're in deep trouble because of costs and lack of availability. This concept didn't actually work in practice in the past.
actually, there wasn't a low risk pool. It was a regular pool and a preferred pool. We also had a "decreasing deductible" where the deductible dropped every year when not reached. ACA wiped all that out and my premiums increased dramatically.
Ask people in your state who got seriously sick and/or had serious pre-existing conditions about how well "pools" worked for them. Your premiums increased, but you're now covered much better in case of serious illness which is the main point of health insurance.
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Re: ACA Struck down...yikes [by federal judge in Texas]

Post by SoAnyway »

nisiprius wrote: Sat Dec 15, 2018 5:17 pm I think this is pretty clearly a "nobody knows yet, we have to wait and see" situation. Press reports suggest that the court ruling is controversial and not at all a slam dunk. This isn't a case where the law is obvious and just hadn't been tested.
J295 wrote: Sat Dec 15, 2018 6:27 pm Life is full speed bumps. When they occur —-accept, adjust, move forward.
Doesn’t seem appropriate to start screaming the sky is falling from a single judge ruling, subject to appeal, for which enforcement has been stayed.
+1 to both of the above.

It's nowhere near time to panic for those who obtain insurance through ACA. This TX case is just one of many court challenges to pieces of ACA. It will wind its way through the appeals process. Other circuit courts may decide similar issues differently. Ultimately, it might end up at the Supreme Court. Or, Congress may act sooner to change the law. Who knows? Either way, it's good to remember that whatever happens to ACA will be, um, "moving at the speed of government", as they say.... ;) And btw, given the various viewpoints on the matter, there will be plenty more challenges to ACA and its various components. I liken the situation to the 80s when I was a college student, and everyone on campus was very attuned to what was happening with Roe v. Wade - on both sides of the issue and of both sexes, btw, and all sexual orientations.

Bottom line: Like many "societal impact" issues, what health insurance looks like in this country will evolve over many years to come and will go through many changes. As J295 said, we will all adapt. It's what humans do. Those who feel strongly (in any direction) on the issue have many options for getting involved and advocating for their desired outcome.

I will be early retiring soon with at least a dozen years to Medicare-eligibility. (Sidebar: What Medicare looks like when I get there will also likely be somewhat different than today, but I digress...) My "Plan A" is of course ACA. I've thought through various other options should that plan become unavailable or suboptimal, based on the facts as they exist today for those other options - which will also of course likely change over time. My view, like J295's: Change is constant. We will adapt. Do what you can to prepare/"Hope for the best, and plan for the worst"/etc.

SoAnyway, I want to say thanks to a couple folks upthread who mentioned an additional option that, in all of my meticulous planning, I had somehow completely whiffed on, to wit:
stan1 wrote: Sat Dec 15, 2018 8:34 am What's actionable now?
- Sign up for 2019 insurance if you haven't and need to do so.
- Save more money if you plan to retire early
- Keep your job with health insurance benefits as long as you can
- Keep your job skills current so you have lower risk of layoff (doesn't always work)
- Marry someone who has more secure health insurance benefits (such as a military retiree)
- Use exercise and diet to hopefully lower your chances of developing a costly medical condition and to manage anything you do have
- Let the people you love and cherish around you know you rely on medical insurance. Maybe some of it will rub off and there will be more empathy.
fortfun wrote: Sat Dec 15, 2018 8:38 pm
jibantik wrote: Sat Dec 15, 2018 6:21 pm
wolf359 wrote: Sat Dec 15, 2018 4:42 pm Is anybody holding off pulling the trigger on retirement due to this issue? Pre-retirement, the main action you can take is to save more or plan for a part-time job that maintains coverage (if you can't get it otherwise.) If your early retirement is unavoidable (such as due to a health issue), I'm not sure what options you might have.
This is why you marry a foreigner and retire in a country with universal healthcare :D
Why didn't you tell me this 23 years ago ;)
Hmm... :confused

Maybe if ACA goes away, I can post a thread in the "Personal Finance (not investments)" sub-forum titled, "Seeking Single BH with Secure Health Insurance" to the effect of:

Single BH with 7-figures invested in a well-diversified portfolio of low-cost index funds seeks single BH with secure health insurance.
Reason? ACA went away. Other options not optimal. I'm fit and healthy with no pre-existing conditions, but who knows what can happen before I'm Medicare-eligible? Citizenship in a foreign country with universal healthcare a +. (Have passport, will travel.) Let's enjoy MFJ status together!!

:sharebeer

Not sure what the mods would do with that, lol. Truth be told, per my "moving at the speed of government" point above, I suspect I'll be Medicare-eligible (whatever that means at the time) before ACA goes away completely.... ;)
Last edited by SoAnyway on Sun Dec 16, 2018 12:02 am, edited 2 times in total.
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Northern Flicker
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by Northern Flicker »

marcopolo wrote: Sat Dec 15, 2018 9:13 pm
dcop wrote: Sat Dec 15, 2018 8:45 pm
Jefferson wrote: Sat Dec 15, 2018 8:35 pm Imagine the size of the pool (and the prices going down due to competition) if groups like the AARP and the NRA could offer group health insurance to its members. There could be a Bogleheads group plan!
While I haven't read into AHP's recently when I did it was still 'employee' driven as far as it mostly applied to Small Biz banding together. I have yet hear of anything like organizations as you mentioned ever getting a pool and developing these plans. Has it ever happened?
Years ago, the IEEE (institute of electrical and electronic engineers) used to offer a group health insurance plans to any of its members. I believe that was set up an a AHP.
It had a $25K or $50K deductible, $1M maximum lifetime benefit, and not offered in all states.

If ACA were repealed, the essential health benefit provisions also go away for employer-based insurance and AHPs.
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Watty
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by Watty »

nisiprius wrote: Sat Dec 15, 2018 5:17 pm I think this is pretty clearly a "nobody knows yet, we have to wait and see" situation. Press reports suggest that the court ruling is controversial and not at all a slam dunk. This isn't a case where the law is obvious and just hadn't been tested.
+1

Especially since even if it was repealed healthcare most likely would not go back to the way it was before.

Even without the court ruling there was little certainty about what healthcare would look like in 2020 and beyond anyway.
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Epsilon Delta
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by Epsilon Delta »

The advantage of Employer health plans to the insurer is that the pool is not* selected based on desire and need for access to insurance. Affiliated plans that are not selective in who can join (and not join) or that allow the affiliates to opt in or out of insurance will find that people who sign up are strongly self selected on the need for access to medical care and such plans will enter the usual death spiral.

* or perhaps I should say was not. If and when insurance becomes a big enough fraction of total compensation this will change.
visualguy
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by visualguy »

Epsilon Delta wrote: Sun Dec 16, 2018 1:57 am The advantage of Employer health plans to the insurer is that the pool is not* selected based on desire and need for access to insurance. Affiliated plans that are not selective in who can join (and not join) or that allow the affiliates to opt in or out of insurance will find that people who sign up are strongly self selected on the need for access to medical care and such plans will enter the usual death spiral.

* or perhaps I should say was not. If and when insurance becomes a big enough fraction of total compensation this will change.
There's another advantage to the insurer with employer health plans which is often missed. Employees need to be healthy-enough to work. Seriously sick people either don't enter the group to begin with, or if they get seriously sick while being employed, they lose their jobs and their employer health plan not too long after that. Obviously, this is not the case with group affiliations which are not based on being employed.
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by A-Commoner »

One possible actionable consequence of this ruling is to move to a state (eg CA) that will more likely than not adopt a universal health law, similar to Romneycare in MA. This might especially be relevant to affluent potential early retirees who have enough means to afford HCOL states like CA : a 40 something person with say $5 million saved up who really wants to retire now but is being held back by the uncertainty of health insurance coverage. The ACA currently provides that guarantee so he can pretty much retire anywhere in the US. If the ACA’s viability continues to be threatened, that person may preempt that by simply moving to (or staying put) in states such as CA that will more likely pass a law that will provide guaranteed universal health coverage. This will ironically lead to some unintended consequences: CA will become even more expensive to live in since state taxes will go up to pay for the health law; yet the population will become more affluent than ever since the state will atttact wealthy early retirees who are looking for that one missing link (guaranteed health insurance) that makes early retirement possible, while driving away poor people who can’t afford the HCOL.
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HueyLD
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Re: Obamacare (ACA) Ruled Unconstitutional by Texas Federal Court

Post by HueyLD »

California here I come!

However, I've been told that there are already 40+ million people there and there is no room for an average dude. I heard that you can move there to retire if you have at least $100M of liquid assets. :P
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