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If you have not heard, the monstrous 2000 page healthcare bill has passed in the House.  It will be debated in the Senate soon, but chances are it will pass in some form.  I am not going to go on about all the things that are wrong about it because that will take too long.  Instead, I will write about who could save money if this bill passes.

First of all, this bill is going to require everyone to buy  government approved health insurance or face a penalty from the IRS.  For individual tax payers, the penalty is   2.5% of gross pay.  For businesses, the tax penalty is 8% of a worker’s pay if the business does not pay for at least 72.5% of the worker’s health insurance premium.  There are also significant government subsidies for those who make under a certain income level to pay for premiums.

Additionally, there will be cuts to FSA and HSA plans and insurance companies will no longer be able to charge more premiums for preexisting conditions.  Also, the premium difference between the young and old will be lessened greatly.  The House bill says that the premium of an elderly person cannot be more than twice than that of a young person.  So essentially these changes will raise the price of health insurance for the young and healthy and punish those who try to save for their own medical expenses.

So what should the young and healthy do if this bill passes?  First of all, stay healthy.  Next,  if employed, ask the employer to give whatever they pay for your health insurance as a part of your pay instead if your employer is paying significantly more than 8% of your pay in health insurance premiums.  You will have to pay the 2.5% in tax penalty, and your employer will have to 8%, but you will have more cash in your pocket.  If you do get sick you will still be able to get insurance since the law basically says that everyone will be able to buy the same basic coverage regardless of preexisting conditions.

How do the numbers work out?  Here is from the Congressional Budget Office that shows how much the average health insurance premiums would be under the new plan for people in different income levels.  For a single person making around $38,000 a year, the estimated premium is $6100 a year, or 16% of income.  Suppose that this person is young and healthy and  simply pays for the tax penalty the cost is only $950 a year. Meanwhile, the person could save the difference.  Of course, right now this person pays no tax penalty, so the government is simply going to redistribute his or her money in subsidies for others.   If you look at the table, it seems that not a single income bracket pays less than 2.5% of their income for the premium, so even the poorest folks would do better to just skip health insurance while they are healthy, save the cash, and simply enroll when they do need to consume health care.  Of course, this will drive up health insurance premiums for everyone who is enrolled, and give more incentive for those who are enrolled to drop their coverage.

How does the math work out for employers?  Lets use the same employee making $38,000 as an example.  The employer is forced to pay 72.5% of the average premium of $6100, which is $4422.50  or  8% of 38,000 which is $3040.  Obviously, dropping the insurance is cheaper for the employer.  If the difference in cost were given to the employee directly then the employee still comes out ahead with more cash in his or her pocket.    When you go up in the income scale, the incentive is even higher to drop insurance.  For example, an employee making $102,000 a year with a family plan would cost   an employer around $15000 a year in insurance premiums or simply $8000 in tax penalties.  If the difference were given to that employee that employee would still come out ahead by several thousand dollars a year after the tax penalty.  That money could be used to pay for preventive care out of pocket.

Finally, lets examine why we have health insurance now.  It is to cialis tadalafil genericagainst future diseases  and healthcare consumption.  Your insurance doesn’t exactly buy you anything you can use right now.  For example, I was pregnant this year, and if I didn’t have health insurance to begin with  I would have had to pay quite a bit for the treatment I received.  Since pregnancy is a preexisting condition and I would not have been able to buy health insurance anywhere while pregnant.  Now if the new law passes, I could buy health insurance while pregnant since it would be illegal to refuse insurance to patients with preexisting conditions.  This completely changes the definition of insurance and makes it almost like a coupon program you can join at anytime.  Basically, your membership fee is your taxes, and then you can pay a middle layer of insurance companies when you need health care.  So, there is really no need to carry expensive health insurance that covers everything  when you are healthy because you can enroll anytime.

If all the young and healthy knew how to do basic math, they would be dropping their health insurance and opt for more cash  pay as soon as this bill is enacted.  Fortunately (or unfortunately) for Congress most American public schools aren’t so great so many people would become new insurance company customers because they cannot figure out that 2.5% is less of a penalty than the 15 or 16% they would be required to shell out.    I don’t know if this healthcare bill would actually raise the percentage of people who are insured because a lot of people out there do have common sense, and businesses will figure out that the 8% penalty is much less than what they would be required to pay otherwise.

So could you save money with Obamacare?  You probably can if you have a preexisting condition and need to consume a lot of health care.  On the other hand, this will cost a lot more for those who are young, healthy, or make too much money.   In the end, it is just and does not do anything at all to improve the quality of healthcare in this country.

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cialis tadalafil genericon 11.10.09 at 9:05 pm

Maybe if we started calling it The Great Outsourcing Bill of 2009 it would get some attention.

As a business owner, I now have *negative* incentive to hire U.S.-based workers. Might as well outsource and save even more money.

This is going to have the opposite effect that the government wants.


cialis tadalafil genericon 11.11.09 at 8:28 am

The “no pre-existing condition” exemption is a landmine for the insurance industry. It will drive all private insurers out of the market for just the reasons you describe. Who indeed will buy insurance until the day they need it? And since the price is set artificially low there will be no profit in selling health insurance. The end result will be everyone signing on to the “government option”, which is in fact the stated desire of President Obama and Nancy Pelosi.

cialis tadalafil genericon 11.12.09 at 3:40 pm

I cannot afford to buy into the government health care plan and cannot afford to pay any fines, how are people going to pay if they have no jobs and no income. I live at proverty level and already have government health care free. Why should I then turn around to buy the same health care when I live at proverty level, who is going to pay for me. The government does not realize that.

cialis tadalafil genericon 11.24.09 at 7:57 am

??? I don’t think I’m following the logic here…maybe I’m just slow.

Let’s see… You opt to pay the fine so that you don’t have to buy health insurance, because you figure you’ll buy insurance after you get sick (let’s say, after you get breast cancer), because insurers can’t turn you down. This will save you a small amount each year. Thus you game the system by staying out of the funding pool until such time as you need help.

But you don’t plan on the car wreck on the freeway. After a Mack truck rear-ends you when you rear-end the guy in front of you who rear-ended the guy in front of him, spinning your car into the moving vehicles in the lane next to you and ricocheting you back into the semi as the 70-mph forces jerk all five vehicles around, you are airlifted to a hospital that can treat not only your brain injury but your probable paraplegia, your ruptured spleen, your macerated liver, and your smushed kidney, to say nothing of several shattered bones.

At the time you are air-lifted out of the accident scene, you are not insured. You remain unable to speak or move your hands for two weeks, because you are on life support in the ICU. During this period you remain uninsured, because a) you can’t ask for insurance and b) even if you could, you couldn’t sign your name on the dotted line.

You remain uninsured when you are rolled out of the ICU into the hospital ward where you will reside for another few weeks. At this point you gasp to a relative that you need to get some insurance. It takes another two weeks to acquire this.

By the time your new health insurance takes effect, you’ve been in the hospital for a month. You owe for an air ambulance ride (ever priced one of those?), brain surgery, spinal surgery, surgery to repair your ruptured visceral organs, life support, anaesthesia, high-powered antibiotics (oh, BTW, while you’re fighting for your life, you pick up an infection, which has to be dealt with expensively), blood transfusions, plasma transfusions, nursing care, pain-killers, food, and the beginning stages of physical therapy and speech therapy.

While you were saving a few hundred bucks a year, the rest of us were paying into the system so that your life could be saved and maybe you might have an outside chance of someday getting out of a wheelchair. It’s unlikely you’ll ever go back to work at a job that will pay the hundreds of thousands of dollars you racked up in the ER, the ICU, and the regular hospital ward. Your insurance coverage now starts after the really expensive stuff has been charged up, and it won’t cover you retroactively. You’ll be deep in debt for the rest of your life.

How does this make sense, again?

And why are we so exercised about asking employers to pay 72.5% of the job-based health premium? Mine is already paying 94%. Since a government-mandated “minimum” quickly becomes the standard, as a practical matter this will mean a drop in health plan costs for many employers.

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