Re: The health care bill is past by just 7 votes!
 

And not just normal cheese either, Swiss cheese ;) with extra holes in them

Re: The health care bill is past by just 7 votes!
 

Yah, I think you are right for the time being, You never know if they will extend it again.

Re: The health care bill is past by just 7 votes!
 

Spot on!

Re: The health care bill is past by just 7 votes!
 

This is speculation on health care for LPRs and won't be known until the regulations are written but I'm going to give my opinion.

From everything I've read about health care reform, all LPRs will be eligible for health care subsidies but LPRs with less than five years are not eligible for medicaid. One government document stated Legal immigrants who are barred from enrolling in Medicaid during their first five years in the U.S. will be eligible for premium credits.

At first I thought the statement didn't make a lot of sense. Did it mean that since they are not eligible for medicaid, they will get no credits since there isn't any credits defined for families below 133% of the poverty line or does it mean that the government will subsidize 100% of their insurance policies? If the government will subsidize 100% of their policies, why not just give them medicaid?

I suspect the government will pay 100% of the premium for LPRs with less than 5 years that are under the 133% poverty level and is doing it that way so that states will not have the medicaid costs (states pay 24%-50% of medicaid costs) since the federal government pays 100% of the premium and preexisting condition subsidies.

This appears to be a slight disadvantage for LPRs with less than 5 years over others because medicaid is generally cheaper to the recipient than subsidies. Generally medicaid recipients pay no copays or small copays ($2-$5), no deductibles or small deductibles, and pay little or no copays for prescription drugs (depends on the state). It appears that health care reform did not define the minimum coverage that will need to be provided by health insurance companies through the exchange and will need to be defined through regulations but is expected to be not as good as what is offered through medicaid.

The following was defined in the bill for minimum coverage by health insurance companies offering coverage through the exchanges.

The coverage must provide for “essential health benefits,” which include ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services.

The coverage must provides limits on cost-sharing.

The coverage must provide bronze, silver, gold, or platinum level of benefits (i.e., benefits that are actuarially equivalent to 60%, 70%, 80%, or 90%, respectively, of the full actuarial value of the benefits provided under the plan).

The Secretary of HHS is authorized to regulate and specify other criteria that must be included in “qualified health care plans.”

Re: The health care bill is past by just 7 votes!
 

Michael - do you have any idea why they included the requirement/restriction above that you must have been uninsured for at least 6 months to participate in this plan? It seems counter-intuitive to me. My g/f just lost her job and is currently on COBRA. She had breast cancer about 5 years ago (since clear). I'm worried that she won't be able to get private insurance once COBRA runs out (current 'pre-existing condition' bullsh*t), and was hoping 'healthcare reform' would help her in that regard. It seems like she'd have to risk going without insurance for 6 months to get this benefit, which runs a huge risk - if something were to develop during that 6 month period she'd be in big trouble?

Re: The health care bill is past by just 7 votes!
 

hopefully they will because I don't know to many people who are on unemployment who are able to pay those COBRA bills, I know I certainly couldn't afford it once the unemployment is taxed and being much smaller than previous salary.

Re: The health care bill is past by just 7 votes!
 

Remember, this is a temporary plan with limited funding ($5 billion) until 2014 and I suspect that they don't want people jumping from a private plan that they already have (even though they have a preexisting condition) to the subsidized plan because it may be cheaper causing the plan to be underfunded.

However, there is a provision in the bill about cobra which requires the employer to offer extended coverage until 2014 if the participant doesn't acquire private health coverage. Also it appears that after 18 months, cobra participants are allowed to go into the high risk pool. I suspect that after 18 months, she will be able to decide which is cheaper and choose whichever plan is the cheapest. I suspect the government allows her to jump to the risk pool because the government is trying to keep the employers group plan costs under control (the employer as well as all employees may end up with significantly higher premiums if someone with health problems remains in the plan for long periods of time) and not create a significant burden of more costs for the employer during this temporary period. Healthy people remaining on cobra for an extended period of time shouldn't have a significant effect on the costs of the plan and if they leave cobra before 2014, they won't get any subsidies but they may possibly be able to get an individual plan cheaper than cobra.

I suspect the main issue with cobra and the health exchange will be when dependents are insured. If one person in the family has health problems but the others don't, can the whole family enroll in the risk pool? That appears to be the case since there is a maximum premium for families in the risk pool.

Re: The health care bill is past by just 7 votes!
 

With 162,000 jobs created in March (some expect the figure to hit as high as 350,000 per month by the summer), I suspect congress is hoping that recently laid off employees will not have the long term unemployment that many people of the past couple of years have experienced and will be able to weather the storm more easily. People that have been previously laid off will still be able to get the cobra subsidy for up to 15 months.

Although the cost of cobra can be very expensive, sometimes it is not too bad. In my case, I paid $237 per month 10 years ago at age 55 with outstanding coverage plus dental and prescription eyeglass coverage. A lot depends on the age and health issues of participants in the group. Some plans are very inexpensive because they are made up of healthy 20 somethings.

Re: The health care bill is past by just 7 votes!
 

My G/F's COBRA is about $450/month for good coverage, full-cost (that is, before the subsidy/etc). Given her pre-existing condition and age (~55), she's quite happy to pay that.

If this is true: "However, there is a provision in the bill about cobra which requires the employer to offer extended coverage until 2014 if the participant doesn't acquire private health coverage" then she'll be in good shape.

Thanks again for your continued flow of good information.

Re: The health care bill is past by just 7 votes!
 

The health care reform plan will likely affect a larger number employees that currently get employer sponsored health insurance than the 31 million uninsured that is expected to be insured under the plan. Although the effect on employees will not be as great, the benefits will likely have a positive significant impact on employees health coverage.

Among other things, health care reform states that employers must provide health care benefits that is at a minimum actuarially equivalent to 60%. It doesn't just require the employer to pay at least 60% of the cost of the premiums but instead requires benefits to be actuarially equivalent to 60%. Because the definition for actuarially means that the employer must estimate the risk of the employees total health care costs and the employee must normally not exceed 40% of the total cost, employers will no longer be able to offer high deductible plans with high copays and limited care and then pay 60% of the cost of the premiums. It requires employers to offer health insurance for both the employee plus dependents which are also included in calculating the actuarial cost.

The following will likely be similar to how an employer will calculate his cost.

Age: 62 with a dependent wife.
Total Cost of Premium: $1,800 per month
Estimated out of pocket expenses: $600 per month
Cost to employer for premium: $1,440 per month ($2,400 * 60%)
Cost to employee for premium: $360 per month

A younger employees cost may be something like the following.

Age: 32 with a family of 4
Total Cost of Premium: $1,200 per month
Estimated out of pocket expenses: $200 per month
Cost to employer for premium: $840 per month ($1,400 * 60%)
Cost to employee for premium: $360 per month

A young single employees cost may be calculated as follows.

Age: 22
Total Cost of Premium: $250 per month
Estimated out of pocket expenses: $25 per month
Cost to employer for premium: $165 per month ($275 * 60%)
Cost to employee for premium: $85 per month

The exact formula will not be determine until the regulations are written.

Besides the above limitations, some employees premium costs may be capped as to the maximum percentage of family income, may be issued a voucher to purchase health insurance through an exchange, the employer opting out and paying fines that allow employees to purchase subsidized health insurance through an exchange, and many other situations.

The following are some links that explain the changes in employer requirements as well as other changes for health insurance.

http://www.nixonpeabody.com/publicat...l3.asp?ID=3233
http://www.journalofaccountancy.com/...y/20102731.htm

Re: The health care bill is past by just 7 votes!
 

Sorry but I think I got that one wrong. That was in the house bill but not the senate bill and suspect it couldn't be put in reconciliation because it didn't affect the budget. I should have investigated that better. When I first posted that earlier, I found blogs and forums claiming that it was in both the house and senate bills so I assumed that it was in the final bill. You'll notice that I didn't post links since I didn't really have any legitimate links to substantiate the claim. Some people may have gotten mixed up because there was a bill introduced in the summer of 2008 to extend the 18 month period but that never got out of committee.

I suspect that your girlfriend won't have problems with the 6 month no coverage provision to get into the risk pool. I also suspect that issue was envisioned and will be clarified when regulations are written for the risk pool.

However, we won't know for sure until the regulations for the risk pool are written later this year.

Re: The health care bill is past by just 7 votes!
 

We do not have 10 employees other than us. Looks like the way to go is to use seperate companies to keep in the small business threshold.

Re: The health care bill is past by just 7 votes!
 

The more I look at health care reform, the more it makes sense. Initially I was concerned that employees may feel at a real disadvantage over self employed people since they may be getting poorer health coverage at a higher cost from their employer and the self employed would be getting lower cost subsidized health insurance through the exchanges.

However with the bill creating regulations requiring employers to also provide high quality coverage health insurance at a reasonable price, this makes things more even. When health care reform kicks in during 2014, many employees may see their health benefits increase, the cost of their premium drop, or possibly both. Few if any should see an increase in premiums or a decrease in benefits.

Since probably more than half of Americans will likely see personal benefits from health care reform, it will likely make them feel better about health care reform.

The increased employer costs due to increased health care benefits and a reduction in employee premiums will likely will likely cause prices to rise. However, all employers will have the similar increases in cost creating an even playing field unlike the current situation which favors the employer with the least benefits. In effect, this is an indirect subsidy to employees that will be paid for by all Americans.

Most small businesses will get a competitive advantage out of health care reform to try to offset some of the advantages that large corporations have such as bulk purchasing and easy availability of financing. Small businesses will get health care subsidies and mom and pop operations will be able to get health care at reasonable prices through the health exchanges. Small businesses that didn't previously provide health care coverage so that the owner could have an advantage over other businesses may suffer. If reducing benefits to employee was his way of making money, he may suffer. However, I'm not sure that we want those types of businesses anyway and if he closes down, other well managed business should easily take over his previous clients.

Large companies such as Walmart supported health care reform because they wanted to be a good corporate citizen but didn't want to be at a cost disadvantage by providing high quality health care at a reasonable cost to employees while other competitors did not.

Conservatives claim that health care reform will be a job killer especially for small businesses. I don't buy that. Good managed small business will have an advantage in health care costs and more people may start their own business since the risks will be reduced. Jobs may be at risk for businesses that are very exported oriented but it seems that would be minor and probably less than normal currency exchange movements.

Re: The health care bill is past by just 7 votes!
 

Do you own the company? If you do, I suppose that would be a way of getting a higher subsidy or lower penalties.

I can't blame you since large companies always setup subsidiaries to get around tax laws or regulations. However, they are more sophisticated than you and can setup subsidiaries in tax free foreign countries.

Re: The health care bill is past by just 7 votes!
 

I have not read all the details, it will be many years before it hits. Any I doubt if it will be the same as it is now.

But I can see there will be a lot of business's restructuring and with CIR in the air it makes employing those missing their documents more attractive.

We could certainly split our business into 2 if need be.