How much is the fine?

Yeah, my company is working with one of the largest healthcare providers in WNY and they are putting on a symposium tomorrow about the ruling. We were working with them today and speaking with their CEO he was stating the costs to the customer will be an increase of $200 - $400 a month...

I think about that and it means my Healthcare costs could rise to $500 - $700 a month and honestly it would basically require me to get a second job to make ends meet. After the divorce it might be a different story, but right now, paying everything I am...I would be beyond broke

1.5% of income in 2014, 2.5 percent of income by 2016 (and with a minimum $95/year, $2,085 maximum/year)

Edit: And $2k per employee/year for companies who don't provide insurance.

Whether or not this is true all it will take is a few stories like this and Romney could win in a landslide. Remember perception is reality and the American voting public has never been super bright. If I'm Romney I just run a bunch of ads talking about $500 a month increase in health costs and I am pretty sure a list of facts won't save that one from going viral. Not sure this is the victory the Democrats really wanted.

I think that is where the tact of paying the fine instead of coverage will work to reduce costs. If the insurance companies threaten to massively raise their premiums, that makes the decision to pay the fines that much easier. If you are making $50K per year, and the insurance company is now saying you are going to be paying $8K per year, you tell your insurance company to go fuck themselves, and pay the $2K fine.

Since insurance companies like profits, and you have to have paying customers to get revenue, they will have to be competitive with the cost of the fine of not buying insurance.

How will this work if you're out of work? A few years ago when I was laid off, I had to pay $1300 a month to maintain health insurance. I know in the great recession they halved this or something. Does this change COBRA at all?

They probably wouldn't say anything that wasn't true to try and get people fired up.

Pretty sure the translation for that is, "We think we can get away with fleecing every one of you for about $3 grand a year by shrugging and saying, 'Pssh. Obamacare, right?' before people begin to take a really hard look at these 2014 Lexuses we're planning on buying."

Your edit part is the section that I'm going to need to deal with if my business continues to grow. Currently, we're under the minimum, but that may change soon. May have to play some games in regards to which employees work for which companies as well. Haven't sat down to figure that all out yet, but it's never too soon to start.

Tangentially tied to inflation. The number currently stands at 400% of the poverty line.

That's probably true but it's reality and a factor that I hope is accurately accounted for in the projections. A lot of plans would work out great if everyone acts morally and predictably.

Honestly, I don't think they're is a heck of a lot we can do unless we really look deep into all of the parts that go into our health and the health care system.

Are these things going to go flat-line or decrease?
*New drugs and treatment options, and the R&D dollars behind them.
*New state-of-the-art technological devices and equipment.
*Malpractice insurance costs.
*Medical school (and undergraduate) costs.
*Building cost and maintenance.
*Will people's lifestyles (a big one in my view) change?
*Won't the aging population see a dramatic increase in the utilization of health care-and the expensive portions of that?

Canada, UK and France all have experience creaks on their increase in spending in regards to their health care systems, and I'm sure a lot of the others are right behind them. I just find it foolish to think that this health care bill will fix any of these things, and why I opposed the bill from the start-it didn't really address what goes into the the creation, maintenance, and delivery of health care and how we live our lives from a health-related standpoint.

It is a $2K per employee charge if you decline to offer any insurance to full time employees when you have more than 50 employees. Doesn't say that you have to pay for it. Also as part of that, the insurance exchanges are to be set up, and tax credits given to business that do cover part of their employees insurance.

From what I understand, it's true. Keep in mind that New York already has one of the most-regulated health insurance industries (MG, which company are you talking about? - I have a good friend who has spent a lot of time on one of these teams). The effect of this legislation in 2014 on most states will be far greater.

It's an interesting paradigm, that's for certain. People in the middle class ($40-$100k/year) going without health insurance so people who earn less can have health insurance.

I don't think this will hurt Obama's chances of re-election. Intrade shows Obama with a small gain today (correcting... both Romney and Obama are down about half a point). Unless there's a jump in unemployment, I think he's going to win. This is still far too esoteric a discussion for most voters. When they see their insurance bills early in 2014, that's when most will react. It was very clever on his part to delay most of the implementation until 2014.

What's the risk/downside if more people and companies than expected pay the penalty, (wait, I'm sorry, "tax")?

Insurance companies revenues go down.

Health insurance plans and premiums are regulated by each state, so they would have to convince the state regulators of the rate hikes. I've never been on the "evil health care companies" train. They're margins are rather weak.

The problem, in my view, is two things:
1) If no can be denied (which is a good thought in theory), then why not wait until you need it? A $2,000 maximum fine is nothing in comparison to what it would cost to cover an expensive treatment (such as cancer or a surgery). Doesn't this allow people to just game the system?

2) How will Medicare play into all of this? They already underpay the costs of delivery, so won't the health insurance mandate and all of that goes into just add more stress on top of the Medicare concerns?

3) What about the economic impact? The rule is if you have 50 or more employees, you have to provide a certain level of insurance, right? Or be fined (the company, not the employees)? Won't this impact how entrepreneurs and companies make future decisions? Seems like you would be penalized for growing and creating jobs, and that outsourcing and relocation could be accelerated even more.

We can always bail them out.

I do think that there's a huge attractive opportunity right now for someone to come along and just Southwest Airlines the hell out of the health insurance industry. Anyone who can figure out what vendors to work with to put a flat fee, widely accepted program out there below, say, $200 per month will just kill the competition.

Health care is not that simple.

I guess we'll learn what the origin/basis of high health care costs really is - is it just caused by insurance companies getting away with whatever they can in a broken system, or is it something else inherent and uncured in the system that companies can't get around with doing something drastic.

I think we should start the FOFC Health Care Collective. aka: FOFCHCC.

1. At the top of every form a customer has to fill out, there will be a picture of a scantily clad woman.

2. Each form that has check boxes will always have a trout option

3. When describing your medical history (known as the Face the Board Form) and you need to continue on another page, you will be given a DOLA form

4. If this is a recurring medical issue, it must be filed in the Dynasty section of record keeping

5. You won't be allowed to fudge your medical records

6. Our doctors must always wear a name tag that says "Hi! I'm Pumpy" and carry a bowling ball bag with them that has all of their doctor tools in it.

7. DT and Jon will be the heads of our Death Panel and all decisions must be unanimous

8. Billy Joel music will be banned at all FOFCHCC facilities

9. No matter a persons past medical history, people will not lose posts

10. If Sports Digs already has it, we'll give you a referral.

There has to be a way to make this work.

As long as any treatment of my sexual nerves is covered, count me in

:eek: :eek: :eek:

I hope you didn't get them from Pumpy?

Absolutely covered. Your records would just be stamped with NSFW.

I don't want to say impossible, but for now, every state has different regulations. In air travel, the product is very simply defined and customers have no rights (we're squeezed into seats the size of Kate Moss's butt and we have less leg-room than even Randy Newman would find acceptable).

The new law is designed to keep employers from dumping employees into the marketplace, so these regulated insurance exchanges are going to be quite tricky. I just don't know how you'd prepare a business model for an industry that's about to change radically.

In theory, yes, there's money to be made here. But the law provides so much protection for the insurance giants that I don't see where.

I realize we're not looking at a comprehensive "all you ever pay is the premium" system with this, but I suspect that healthcare really does get simpler the less you have to worry about 'what's covered' and 'what's preexisting' and, the critical part, 'how much can we get away with charging'. Healthcare costs in most of the developed world are under $4,000 per capita, including catastrophic and emergency medical. With 15% of the US getting added into the system, each of whom in a few years will be getting dinged for $2K in penalties without benefit anyway if they don't select a provider, I just don't see the rationale for claiming that this particular legislation is going to add 30% to the costs of seeing the doctor - the increases we will see are forecasted regardless of who's paying.

Regardless, right now we don't see any meaningful competition in the health marketplace - the lengthy and torturous process to shop for the best healthcare deal is the biggest obstacle to lower pricing, in my opinion. Maybe the price point isn't $200 - maybe it's $300, maybe $400 - but someone out there has a real opportunity, especially with the pre-existing clauses removed, to agree to forego huge margins, sweep most of the differentiation under the hood, and offer a blanket price to anyone. I think that kind of message has a huge opportunity to resonate with the public.

The problem with health care costs - other than simply being too fucking high I mean - is that it seems to be a hydra that requires near simultaneous handling of all heads to have a reasonable shot at defeating it.

My experiences lead me to doubt we have the ability and the resources to do that. Those same experiences convince me that we lack the collective will to do so even if we had every other necessary tool.

Fuck me - I think we agree on something else.

BCBS of WNY aka HealthNow....We will be providing the video stream to all the news outlets that are running the symposium on their websites.

I will tell you this much as well, my insurance at close to 400 a month sucks ass and I hate the hoops I have to jump through just to go to a specialist.

Alrighty...note to self: Amend item number 7 for the FOFCHCC.

Didn't say we agreed on death-panel decisions :) . There are a (limited) number of things that we agree on after all.

Given the rather depressing conclusion I had drawn there, it may actually be an even bigger bummer that we're in basic agreement about it. I mean, it's pretty much a declaration of "we're screwed" ... and we probably both agree that isn't exactly the optimal outcome for anybody either.

In New York, profits are already regulated - and under Obamacare, this will be the case nationally.

You're right that a blanket price is closer to reality when restrictions on pre-existing conditions come into play.

Cynically, the business opportunity comes into play when capturing relatively healthy people. But how do you do that? Most healthy people are employed and the money is going to be in negotiating with large employers. For them, little will change under the new law.

What remains is the Battlestar Galactica of customers. You make money by picking out the best of the independent ships. But the legislation will prevent you from discriminating against anyone. So if you offer a great product, the first to sign on will be the ones who have serious pre-existing conditions. Healthy uninsured people will hold out as long as they can.

This is a big part of the reason why the insurance giants thrive under the current system and will continue to thrive.

The total amount spent won't change much, up or down, with the new legislation. It increases because health care costs are increasing. To address that, we need real health care reform, not a cynical piece of legislation designed for political appeal and corporate interests. I think the biggest gains under this legislation will be with the hospitals. However, there will be pressure to regulate payments to hospitals once this takes effect, so I'm not sure this will be a long-term gain.

This is an incredibly complex law, even though it doesn't address the core of the problem at all.

Tangental to the topic of the day perhaps but I've been amused by this observation attributed to P.J. O'Rourke, about the need for two new political parties: one for those with his mixture of views, another for those who hold the opposite mixture.

Not sure why exactly, but that has amused me today.

I hope there's not some kind of quota. :D

My non-rant, for those who are curious. About 1,300 words but only around 900 of them are my own. I borrowed the rest ... borrowed mind you, neither taxed nor fined :)

And in other news … | Jon's Three Cents

They do tingle when he's near

Ok, someone start looking for that singularity that just opened up....Both DT and I agree with Jon......


I need smelling salts....

Help....everything is going dark....

Well don't call a doctor, the free health care ain't kicked in yet ;)

Were the Paquiaou-Bradley judges subbing for the supreme court today

Busy day. Just checked the net.

Thank you Chief Justice Roberts. If Obamacare survives the next several years, I think this is the legacy you will be remembered for.

GOP will play this to the hilt in the elections and Healthcare will be getting alot of publicity rest of the year. I like the exposure, key issue for me the last election and this coming one.

If the GOP can come up with something meaningfull (vs McCain's $2,500 tax rebate) which will also help the unfortunate, uninsured (and kids of), I'll seriously consider voting GOP as I like Romney.

Maybe I'm just overly optimistic, but I just don't see all these votes the GoP thinks they have heading into this election.

The Black vote Obama's
The Latino vote right now is almost 3-1 in Obama's favor
The right has pissed off pretty much any woman not married to a right wing male.

So otehr than the old fart white guy vote, who is voting for the GoP?

I've seen nearly as many livid women today as I have men, or maybe more accurately they've been more derisive about the decision (while the men have been more angry). And, now that I think about it (since you mentioned marital status) I think there were actually more of them single than married.

I don't really want to get into a public debate about this stuff since this thinking about and implementing this law is what I do for a living but I'll comment on a few things.

Galaxy is right, the margins for health insurance companies are poor compare to other industries. Even if the insurance companies never profited another cent there wouldn't be much savings because without the insurance cos fighting for those profit dollars - they will just be seized by expanding margins for providers. Now maybe you think that is better - which is fine, but don't fool yourself into thinking there would be savings.

There are no accounting tricks to really be had on the MLR rebates. The pools are strictly regulated and it is quite easy for regulators to see the differences between your statutory accounting and your MLR filings. Certainly there is some gray at the edges, but if you run at a 75% loss ratio and don't pay rebates it won't take long until the fines roll in.

A Southwest type carrier that could compete with the national carriers is impossible. Most importantly you need membership scale to negotiate competitive deals with provider systems, without that you can't compete. You can't get the membership without sales, underwriting, actuaries and service people. If you somehow convinced providers to take global caps over fee for service.... But don't worry that isn't happening.

One thing a lot of you seem to be ignoring is that the ACA came with rate review - so in the individual and small group market if you want more than a 10% increase the state needs to approve. The idea that after 1/1/14 insurance companies can use any rates they like is 100% incorrect.

This law is not great (more bad than good), I still was personally happy to see it stick
- without it having 50 states doing 50 things would be worse for everyone in the long run.

A few interesting theories about how things may have shaken out behind the scenes (Scalia's dissent may have started as the majority, Roberts may have written much of the dissent before he swapped on the tax issue). It's sounds a little like a contrived storyline built around Roberts' unexpected vote, but they raise some good points.

The Volokh Conspiracy » More Hints that Roberts Switched his Vote

I never understood the vitriol regarding the law. A lot of it seemed to already have been a part of laws that group plans have (put in place by evil socialist Ronald Reagan). It really doesn't change a lot for most people and I do think it helps those who do have preexisting conditions or come down with something while insured. My small business has benefited from the credit we get for having people on our plan. It's by no means perfect, but it's also not bad.

There are far bigger issues out there in the health care landscape that need to be addressed. This just seems like a silly thing for people to start a political war over.

I don't get this line of thinking. Health insurance costs are passed on through to the employee even if it doesn't show up in their check. Just like the payroll tax, unemployment insurance, and any benefits you're providing (401K match, etc). There are only a handful of scenarios that I can configure where this would hurt a business, and those would seem relatively rare. And health care premiums are tax deductible to your business, something I don't believe the penalty is.

Hiring is based on demand. If people are lining up down the street for your service, you'll hire people to fill that demand. If health care costs go up for an employee, they'll simply take home less cash in their paycheck. And if you don't offer them health insurance at all, you'll have to make up for it by offering a higher salary and thus eliminating any perceived savings you would have.

It's not a great bill and the brouhaha over it is overated. It doesn't address the biggest problem with health care which are the rising costs. It should not have any impact on your hiring practices though. It simply spreads out the responsibility and shifts where payments come from.

You own a business like I do which is why you shouldn't be touting the "people will get fired" propaganda you hear. You know that has nothing to do with hiring, just like your own personal income tax rate has nothing to do with hiring.

I wish we could figure out a way to detach health insurance from our employment situation, like the Switzerland private health care model.