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lifetravelergirl
10-25-2013, 06:22 AM
another 'clarification' just released regarding the ObamaCare IRS penalty for failure to purchase 'qualifying' health insurance ... from


(snip)"The Joint Tax Committee prepared a summary of Obamacare that includes this discussion of the mandate:


The penalty applies to any period the individual does not maintain minimum essential coverage and is determined monthly. The penalty is assessed through the Code and accounted for as an additional amount of Federal tax owed. However, it is not subject to the enforcement provisions of subtitle F of the Code. The use of liens and seizures otherwise authorized for collection of taxes does not apply to the collection of this penalty. Non-compliance with the personal responsibility requirement to have health coverage is not subject to criminal or civil penalties under the Code and interest does not accrue for failure to pay such assessments in a timely manner.


As I understand it, the only way the IRS can possibly collect the penalty is by withholding your tax refund. No problem: if you arrange your taxes so that you don’t overpay, the penalty can never be collected from you.

Which is to say that there is no penalty for failing to comply with the Obamacare “mandate.” Many commentators have pointed this out, including us. Oddly, however, some observers who should know better continue to tell young people they should pay the penalty and forgo expensive insurance. No: young people, if they want to follow their self-interest, should forgo expensive insurance and NOT pay the penalty, because it can never be collected from them."(snip)


Thus for 'non-employee' independent contractor dancers and camgirls, by carefully managing your estimated tax payments to assure that you'll wind up having to pay in a small additional amount along with your annual tax return ( thus no refund ), it's 100% legal for you to NOT buy ObamaCare health insurance and also NOT actually pay the new IRS penalty.


Thank you Melonie,

Can you please include links to the material you quoted (if possible).

Melonie
10-25-2013, 07:45 AM
here's one of the more authoritative interpretations of the Joint Committee Report from Professor Caron of Pepperdine U School of Law ...


(snip)"Here is what the federal Joint Committee on Taxation had to say about this issue in a report released earlier this week:

Individuals who fail to maintain minimum essential coverage in 2016 are subject to a penalty equal to the greater of: (1) 2.5% of household income in excess of the taxpayer’s household income for the taxable year over the threshold amount of income required for income tax return filing for that taxpayer under section 6012(a)(1); or (2) $695 per uninsured adult in the household. The fee for an uninsured individual under age 18 is one-half of the adult fee for an adult. The total household penalty may not exceed 300 percent of the per adult penalty ($2,085). The total annual household payment may not exceed the national average annual premium for bronze level health plan offered through the Exchange that year for the household size…

The penalty applies to any period the individual does not maintain minimum essential coverage and is determined monthly. The penalty is assessed through the Code and accounted for as an additional amount of Federal tax owed. However, it is not subject to the enforcement provisions of subtitle F of the Code. The use of liens and seizures otherwise authorized for collection of taxes does not apply to the collection of this penalty. Non-compliance with the personal responsibility requirement to have health coverage is not subject to criminal or civil penalties under the Code and interest does not accrue for failure to pay such assessments in a timely manner.

According to a footnote in the report, “subtitle F of the Code” is the portion of the tax code which grants the IRS the authority to assess and collect taxes. In other words, as the law is written the federal government has no legal authority to enforce this mandate, nor will it have any recourse to collect any penalties that go unpaid !"(snip)


Other sources made the observation that the IRS could 'seize' the amount of the ObamaCare tax penalty out of excess tax withholdings on the basis of accounting for the ObamaCare tax penalty as an additional amount of tax owed, because the IRS already holds these funds ( thanks to quarterly estimated tax payments by self-employed persons, or employer payments of estimated taxes withheld from employee paychecks ). This would result in a reduced amount of tax refund being paid out by the IRS to the person. However, if the person has previously adjusted their estimated tax payments / paycheck tax withholding downward to assure that there aren't any excess tax withholdings being placed in the hands of the IRS, then the IRS has no excess funds available from which to 'collect' the ObamaCare tax penalty ... and no legal authority to attempt to collect additional funds from that person.


The actual complete gov't report is available at

Eric Stoner
10-25-2013, 08:05 AM
Yes! And the point of my post is melonie is always saying there's no need for young healthy cam, strippers to have it!

Whoa ! When did she EVER say that. Not that I know of. What she has posted against are things like coercion and forcing people to get policies that cover things that they don't and never will need ( pregnancy care for men ; prostate exams for women etc. ) Just to cite one example of her many reservations about Obamacare.

To try and avoid this getting political let's all please try to keep this as factual and practical as possible. For instance, if I am mistaken and young people can still opt for catastrophic coverage then please post something to that effect. According to Melonie ( and I have no reason to doubt her ) many such policies are being cancelled.

Eric Stoner
10-25-2013, 08:07 AM
Technically speaking, an uninsured person diagnosed with cancer can sign up for ObamaCare, pay one month's insurance premium plus their deductible, and the costs of any cancer treatments exceeding the $6,350 annual out-of-pocket limit will be 100% paid for by ObamaCare insurance.

Well, with one qualification ... any cancer treatment that is 'approved' by the ObamaCare Independent Payment Advisory Board. For a 25 year old, odds are that extensive treatments will be 'approved'. However if the person is 55 years old, maybe not ...

from http://www.usnews.com/opinion/articles/2012/12/10/the-truth-behind-obamacares-death-panels?page=2

(snip)"cost has to be a consideration when it comes to healthcare, as it is with every decision made in life. Everyday Americans weigh costs against the benefit of additional safety, when we buy cars, new appliances, or decide what path to take home. Yet such cost-benefit considerations should be made, whenever possible, at the individual level. Americans should be concerned when it is the government, or in the case of Obamacare, a small cadre of politically-influenced bureaucrats that comprise the Independent Payment Advisory Board, who are tasked with making a cost-benefit analysis for all Americans."(snip)

As yet we don't know how the new IPAB will actually operate. However, based on similar bodies in the UK, Canada and other countries with socialized medicine, the 'approval' of expensive treatments will be based on a cost vs benefit calculation based on the probability that the patient will 'recover', the probable number of years the patient's life will be extended by the treatment, the 'quality' of life the patient will wind up having after the treatment etc. See http://www.slate.com/articles/news_and_politics/jurisprudence/2013/10/canada_has_death_panels_and_that_s_a_good_thing.ht ml This is a departure from current US health insurance, where a health insurance policy either covers a particular procedure for everyone who has that insurance, or it doesn't.




Essentially, this was my earlier point. In the final analysis, under the new ObamaCare rules which force insurers to cover people with pre-existing conditions at the same premium price as healthy people, young Americans have extremely little to gain and not much to lose by choosing NOT to pay the $2,000-$3,000 annual ObamaCare premium cost while they are healthy, versus paying the $400 IRS penalty and going without insurance until the point that they actually become sick or injured thus will actually have to pay major medical bills !!!

Exactly ! I personally know two people who did not have insurance ; were diagnosed with a problem and have now signed up for Obamacare. Clearly they waited to get sick before spending money on health insurance.

Melonie
10-25-2013, 08:10 AM
^^^ yes, young people can still opt for 'catastrophic only' coverage with associated very low monthly insurance premiums. However, this also requires that health insurance companies will continue to offer such limited coverage as a private insurance market option ( which increasingly appears NOT to be the case, given all of the news media announcements of 'non-qualified' insurance plans being cancelled by the hundreds of thousands - see ). And, if still offered, as 'non-qualified' insurance coverage, it would still subject the buyer to paying the new ObamaCare tax penalty ( which may or may not actually be collectible based on the above posts ) in addition to the insurance premiums .

And yes, with all forms of medical history / pre-existing conditions removed from ObamaCare's insurance eligibility and monthly premium costs, a healthy young person and a young person just diagnosed with cancer will receive the same health insurance coverage and same monthly premium cost under ObamaCare. As such, there really isn't any 'necessity' to have / pay for health insurance coverage before you become sick !!!

The 'old' paradigm, of course, was that insurance companies could deny health insurance coverage to people with health problems / pre-existing medical conditions, or that health insurance companies could quote incredibly high monthly premiums if they DID agree to write insurance coverage. This provided healthy young people with a motivation to buy health insurance coverage while they are healthy, such that if and when they did develop medical problems that their existing low cost insurance coverage would foot most of their medical bills. But with ObamaCare forcing insurance companies to write coverage regardless of the person's health, and with ObamaCare forcing insurance companies to charge the same monthly premium amount for a healthy person and a sick person ( of the same age and income level ), that former motivation is no longer valid.

xxxGothBarbie
10-25-2013, 08:21 AM
I don't need health insurance..ever hardly! This whole thing is utter bullshit & I'm gonna avoid it as much as I can. Technically I don't "work" & don't pay taxes so I'm not worried. You can't force that on someone if they aren't working....wow this country fucking amazes me sometimes

Melonie
10-25-2013, 08:26 AM
^^^ actually, if your 'reported' income is less than 133% of the Federal Poverty Level ( about $14k per year for a single person ), they can 'force' you to sign up for Expanded Medicaid the minute that you walk into a hospital ER !!! As such, Expanded Medicaid will pay for your treatment ... and for future medical expenses. However, the state Medicaid dep't will also keep track of the total amount of money spent on your medical treatments, on top of tacking on an annual 'administration fee' for the Expanded Medicaid coverage, and when you turn age 55 the state Medicaid dep't can attempt to seize your assets ( house, car, investments, bank balance etc. ) to 'repay' the state !!!

Because of this Medicaid 'claw-back' provision, I am hearing that a lot of low income people are scrambling to get their reportable earnings above the 133% 'dividing line' between Expanded Medicaid and ObamaCare insurance coverage. Because Medicaid is not insurance, when a person who received Medicaid funded medical treatment reaches age 55, the state can attempt to 'claw-back' the ENTIRE AMOUNT of the health care cost. One treatment for a serious illness or accident could result in $100,000+ worth of medical bills ... that you as an Expanded Medicaid recipient will be expected to repay after your 55th birthday. And if you don't have the 'cash' available for said repayment, the state has the legal authority to place liens on, and eventually seize and liquidate, any assets that you have accumulated as ( partial ) payment.

xxxGothBarbie
10-25-2013, 08:31 AM
yea well I'm terrified LOL Let them "seize" all they want.... I don't have major assets, I'm a minimalist I don't have anything they'd want

Melonie
10-25-2013, 08:37 AM
^^^ That's a perfectly valid position ... but it will also potentially 'doom' you to never buy a house, to never save money toward your retirement etc. ... because if you do get sick one time, when you turn age 55 the state can 'take away' that house, that retirement money etc. to repay Medicaid for medical treatments you received 'for free' decades earlier.

This is SERIOUS stuff ... from


(snip)"I've been looking into this issue for the last couple of years, and here's something I think is very important that many people don't seem to be thinking about: Medicaid + ACA + Estate Recovery = a mechanism whereby a large number of people in the lower income brackets may be just about to find ourselves paying hugely disproportionate sums for the privilege of being covered by Medicaid, even briefly or intermittently. There's a nicely succinct explanation on this page:


Affordable Care Act of 2010. Estate recovery will be forced on millions of people who might have otherwise gone without insurance. Why? Because the plan is that millions more Americans have health insurance. That would be accomplished by expanding Medicaid and implementing premium assistance (subsidies). When a person is found to be eligible for Medicaid, they will be automatically enrolled into their state's Medicaid program. Those forced into Medicaid will, due to the federal law, also be forced into estate recovery. Their estates will be partly or fully taken over by the federal or state government when they die.


So here's the deal: since 1993 there has been a federal law requiring states to recover at least some of the costs of Medicaid-covered medical care for anyone 55 years old and up, from the estates of those covered.

States enforce this law, with their own laws and policies added in, differently in every state. But the general principle is there. Up until now the usual consequence has been things like this: Medicaid puts a lien on the house of someone in a nursing facility who has run out of money, and after they die, the heirs find they have to buy the house back from the state if they want it.

We haven't had lots of people younger than 65 on Medicaid, because in most states simply earning less than the Federal Poverty Level did not qualify one for Medicaid.

And we haven't had many people with lots of assets on Medicaid, because in most places you have to have less than around $2400 to your name before Medicaid will cover you. You can keep your house and your car, but Medicaid reserves the right to put liens on them and take them when you die.

But now we have the Affordable Care Act, and its expectation that everyone in the lower tier of income will end up in the Medicaid system. To accomplish this, they have dropped the asset test. So now we will have lots of people ages 55-64, who have assets but not a lot of income right now, for whatever reason, on Medicaid.

The kicker of it is, if you make the right amount to qualify for a subsidized health insurance plan, your costs are going to be shared and subsidized by the government. But if you go on Medicaid, you owe the entire amount that Medicaid spends on you from the day you turn 55.

And that amount is not just what is spent on your doctor visits and your treatments, whatever they may be. No, there is also something called a "capitation charge." For each enrollee, a base cost is assigned to the entity that administers the program. How much will that charge be? It varies by state, and as far as I can tell by other variables as well, but it could be hundreds of dollars per month, or more. (If you have specific information on this, please do share it!)

How will this play out? No one knows, as far as I can tell. But it is easy to see how this could become a real problem. If someone is low income and goes on Medicaid, will Medicaid put a lien on their house? If they need to sell their house and move, will they then lose all their equity in paying off the lien? Will people get hit with bills and liens for many thousands of dollars, even if they were healthy and hardly ever went to the doctor?

Why is it that Medicaid is pretty much cost free to use up to age 54 if you qualify, and suddenly becomes a collateral loan at age 55, for which a state agency will do its best to collect payment in full for every cost assigned?"(snip)


Bottom line appears to be that, if a person has an income that is less than the 133% of Federal Poverty Level, and that person winds up being signed up for the Expanded Medicaid program, and in turn that person winds up receiving any sort of serious medical treatment, that they might as well figure on remaining a low income person for the rest of their life. Actually, if the amount of the Medicaid 'capitation charge' is really a couple of hundred dollars per month, you don't even need to receive expensive medical treatment under Expanded Medicaid to be facing a huge 'bill' on your 55th birthday. Or put another way, there's no point in working your butt off to earn more money and accumulate assets that the state is just going to 'claw' back from you when you reach age 55 via liens and eventual liquidation !

AureliaC
10-25-2013, 11:45 AM
^^^ actually, if your 'reported' income is less than 133% of the Federal Poverty Level ( about $14k per year for a single person ), they can 'force' you to sign up for Expanded Medicaid the minute that you walk into a hospital ER !!! As such, Expanded Medicaid will pay for your treatment ... and for future medical expenses. However, the state Medicaid dep't will also keep track of the total amount of money spent on your medical treatments, on top of tacking on an annual 'administration fee' for the Expanded Medicaid coverage, and when you turn age 55 the state Medicaid dep't can attempt to seize your assets ( house, car, investments, bank balance etc. ) to 'repay' the state !!!

Because of this Medicaid 'claw-back' provision, I am hearing that a lot of low income people are scrambling to get their reportable earnings above the 133% 'dividing line' between Expanded Medicaid and ObamaCare insurance coverage. Because Medicaid is not insurance, when a person who received Medicaid funded medical treatment reaches age 55, the state can attempt to 'claw-back' the ENTIRE AMOUNT of the health care cost. One treatment for a serious illness or accident could result in $100,000+ worth of medical bills ... that you as an Expanded Medicaid recipient will be expected to repay after your 55th birthday. And if you don't have the 'cash' available for said repayment, the state has the legal authority to place liens on, and eventually seize and liquidate, any assets that you have accumulated as ( partial ) payment.

Age 55... new deadline for getting the hell out of this country.

Melonie
10-25-2013, 02:13 PM
too late ^^^ - see

(snip)Those “other purposes” have come to include a little-known amendment recently introduced by Senate Majority Leader Harry Reid that would allow the State Department to revoke, deny or limit passports for anyone the Internal Revenue Service certifies as having “a seriously delinquent tax debt in an amount in excess of $50,000.”

While the provision does make exceptions if the debt “is being paid in a timely manner” or “in emergency circumstances or for humanitarian reasons,” it doesn’t require that a person be charged with tax evasion before having their passport revoked -- only that the IRS has filed a notice of lien or levy against them.(snip)


So if the IRS 'asserts' that a person owes $50k+ in accumulated unpaid ObamaCare tax penalties, or owes $50k+ in unreimbursed Expanded Medicaid costs, that person isn't going to be allowed to leave the country !!!

AureliaC
10-25-2013, 02:28 PM
I believe I'm just under $50,000. So what happens if you're still broke at 55? They just cut off your medical insurance and try to take whatever you have? Love the way our country treats senior citizens. How do they figure it's ok to just give subsidies to those who make enough to live, but lend it to the people who are broke as hell?
Funny how when all my doctors and the DSHS workers told me to get on medicaid for my pregnancy they never mentioned that in return they'd want interest, and my freedom. I'd have gone with a goddamn loan shark if I'd known.

Melonie
10-25-2013, 02:57 PM
^^^ no, if you're still 'broke' at age 55, if you don't have any assets which can have liens placed against them by the IRS / state Medicaid dept's, then you effectively have nothing to 'lose'. And you'll continue to receive ( Expanded ) Medicaid coverage until you become eligible for Medicare at age 65 / 66 / 67. So in effect, the 'claw-back' provision creates a 'moral hazard' situation where, once a person has been signed up for Medicaid and has received medical treatment paid for by Medicaid, it really doesn't 'pay' for them to attempt to increase their future ( reported ) earnings beyond 133% of Federal Poverty Level.

As to DSHS workers ... and ObamaCare workers ... not really informing would-be ( Expanded ) Medicaid recipients of the potential future ramifications of the 'claw-back' provisions, what can I say !!! Not much without violating the SW politics ban !!!

AureliaC
10-25-2013, 03:02 PM
At that point with my health conditions I could easily be making too little to cover a rental payment and food, but if I have my house and cars paid off I would still have assets. I'm just going to sit here breathing through a paper bag for the next few hours.

The U.S government's constant incentives not to work, acquire assets, or do anything but drain the rest of society can't possible be unintentional. It's too effective.

Melonie
10-25-2013, 03:11 PM
^^^ well, upon reaching age 55, your house and car would no longer be 'paid off' even if you had previously done so ... given that upon reaching age 55 the IRS and state Medicaid dept. can place new liens against your house and car to 'claw-back' the cash value of ( Expanded ) Medicaid benefits you received in previous years / decades. This doesn't mean that you can't still use your house and car, only that in order to sell them or pass them on to your children the amount of IRS and state Medicaid dept. liens must first be paid off ( by you or your children ).

I am also told that there are now restrictions in place regarding the ability of a person to transfer title to another person if potential Medicaid 'claw-back' action is pending. This had already become an issue under Medicare, where aging parents attempted to transfer ownership of the family home to their children prior to being placed in nursing homes so that the IRS / Medicare couldn't 'seize' it in payment for medical benefits provided ( thus depriving the children of their inheritance ). This now has the potential for becoming a 'new' problem, given that Expanded Medicaid will now create a scenario where lots of Americans far younger than age 55 will be signing up for Expanded Medicaid coverage and receiving medical care paid for by Medicaid. As the author of one of my link stories speculated previously, will this mean that a person having previously received Expanded Medicaid funded medical care ... at say age 40 ... being prevented from selling a house they own without immediately having to pay Medicaid escrowed 'claw-back' money from the proceeds of the property sale ( thus preventing that person from having enough remaining money to buy a different house in a different city ) ? We don't know yet, but we'll start finding out in 2014.



The U.S government's constant incentives not to work, acquire assets, or do anything but drain the rest of society can't possible be unintentional. It's too effective.

Again I can't comment on this due to the SW politics ban. However, I can point out the following factual info regarding 'effectiveness' ... from


(snip)Americans who were recipients of means-tested government benefits in 2011 outnumbered year-round full-time workers, according to data released this month by the Census Bureau.

There were 108,592,000 people in the United States in the fourth quarter of 2011 who were recipients of one or more means-tested government benefit programs, the Census Bureau said in data released this week. Meanwhile, according to the Census Bureau, there were 101,716,000 people who worked full-time year round in 2011. That included both private-sector and government workers.

That means there were about 1.07 people getting some form of means-tested government benefit for every 1 person working full-time year round.

The Census Bureau counted as recipients of means-tested government programs “anyone residing in a household in which one or more people received benefits from the program.” Many of these people lived in households receiving more than one form of means-tested benefit at the same time."(snip)

AureliaC
10-25-2013, 03:24 PM
That was my point, that you can be broke as hell as still get your stuff taken after you die.
I did a bit of research before going on pregnancy medical, and all I could find was that they would take control of your assets after you die if you've been on long term care. Nothing about medicaid, so FML

lifetravelergirl
10-25-2013, 08:53 PM
I am still trying to figure out if I have to buy health insurance that I can't afford and I am older than 30 btw. If I had any extra money per month I would be paying down my credit card debt. I do make payments on a house, I have to rent it out because I can't afford to live in it. Personally I think our government sold us to the banks and corporations and the reason the government is giving machine guns to police departments and forest rangers, militarizing everyone and stockpiling ammunition is because they plan on taking everything we own at gun point. http://nowtheendbegins.com/pages/obama/fema-camps-obama-private-army.htm I don't think we need to fear any attack on the USA, the attack will come from our own government.

Good times though. ^_^

charlotte.
10-25-2013, 09:23 PM
I am still trying to figure out if I have to buy health insurance that I can't afford and I am older than 30 btw. If I had any extra money per month I would be paying down my credit card debt. I do make payments on a house, I have to rent it out because I can't afford to live in it. Personally I think our government sold us to the banks and corporations and the reason the government is giving machine guns to police departments and forest rangers, militarizing everyone and stockpiling ammunition is because they plan on taking everything we own at gun point. http://nowtheendbegins.com/pages/obama/fema-camps-obama-private-army.htm I don't think we need to fear any attack on the USA, the attack will come from our own government.

Good times though. ^_^


if you're in one of the states that opted out then you dont need to get ins. if you aren't, then you could qualify for medicaid. you also dont have to get ins if its going to be more than 8% of your income.

as for the rest of your post...um, its not really related at all to obamacare.

AureliaC
10-25-2013, 11:03 PM
I am still trying to figure out if I have to buy health insurance that I can't afford and I am older than 30 btw. If I had any extra money per month I would be paying down my credit card debt. I do make payments on a house, I have to rent it out because I can't afford to live in it. Personally I think our government sold us to the banks and corporations and the reason the government is giving machine guns to police departments and forest rangers, militarizing everyone and stockpiling ammunition is because they plan on taking everything we own at gun point. http://nowtheendbegins.com/pages/obama/fema-camps-obama-private-army.htm I don't think we need to fear any attack on the USA, the attack will come from our own government.

Good times though. ^_^

Wish i could just blow you off as a a conspiracy theorist, but they're trying to keep our military elsewhere and our police are getting awfully well armed.

lifetravelergirl
10-25-2013, 11:12 PM
if you're in one of the states that opted out then you dont need to get ins. if you aren't, then you could qualify for medicaid. you also dont have to get ins if its going to be more than 8% of your income.

as for the rest of your post...um, its not really related at all to obamacare.


I guess time will tell. Personally I believe that Obama Care is part of a concerted effort to crash the economy, one that has been in place since before Obama became president and one in which Nafta and Gatt were instrumental.

According to a previous post in this thread, if I qualify for medicaid and if I receive care through medicaid then when I reach the age of 55 my house can be taken away from me in order to repay my expenses.


^^^ well, upon reaching age 55, your house and car would no longer be 'paid off' even if you had previously done so ... given that upon reaching age 55 the IRS and state Medicaid dept. can place new liens against your house and car to 'claw-back' the cash value of ( Expanded ) Medicaid benefits you received in previous years / decades. This doesn't mean that you can't still use your house and car, only that in order to sell them or pass them on to your children the amount of IRS and state Medicaid dept. liens must first be paid off ( by you or your children ). ...



Which states have opted out?

charlotte.
10-26-2013, 02:27 AM
if youre atate is a "red state" then its likely tohave opted out. unfortunately I can't find a good list for you. you'd be better off googling "did [my state] opt out of obamacare?" since its up to the states to opt in or out, not only is it.difficuly to track sides but its also possible yhat party lines will change after november (if yhere r elections for congress or g overnor) so your states status may change soon

Melonie
10-26-2013, 03:13 AM
States shown in red will operate their own exchanges, which also means that they will offer Extended Medicaid at incomes up to 133% of Federal Poverty Level ( about $14k per year for a single person ) without an 'asset test' for eligibility.


http://obamacarefacts.com/obamacarefacts-images/public-domain/insurance-exchange/state-health-insurance-exchanges.jpg



According to a previous post in this thread, if I qualify for medicaid and if I receive care through medicaid then when I reach the age of 55 my house can be taken away from me in order to repay my expenses.

Well, not exactly. If you qualify for ( Expanded or Regular ) Medicaid and if you receive medical care paid for by Medicaid, then when you reach age 55 the state will try to recover the 'cash value' of that medical care ( plus annual administrative expenses for the time you were covered by Medicaid even if you didn't receive expensive medical treatments ). The most common way for the state to do this is to place a lien on your assets i.e. house, car etc. when you reach age 55. This does NOT mean that the state will immediately seize these assets. But it does mean that you cannot sell these assets, nor pass them on to your children, until Medicaid has been repaid.

As pointed out by one of my previously posted link stories, right now there isn't very much 'precedent' in this regard, since qualifying for regular Medicaid has an eligibility test such that if you own a home, own an expensive car etc. you will not qualify for regular Medicaid. However, ObamaCare's Extended Medicaid waives that asset test, such that lots of people who own homes, own nice cars etc. but who also happen to have low incomes at the moment, will become eligible for Extended Medicaid. In fact, the new state run Public Health Exchanges ( shown in red above ) will be signing up people whose incomes are below 133% of Federal Poverty Level for Expanded Medicaid rather than giving them the option of purchasing ObamaCare health insurance.

As also pointed out by one of my previously posted link stories, one important unknown factor for which there isn't any 'precedent' is how Medicaid will handle people who receive benefits under Expanded Medicaid say 10 years from now, when they want to sell their house etc. By that time, the person could have easily racked up $50,000 worth of medical treatments under Medicaid plus another $25,000+ in monthly Medicaid administrative expenses. Will Medicaid block the sale of the house to insure that they will eventually get 'repaid' ? Will Medicaid immediately step in and seize $75,000 from the proceeds of the sale to be held in 'escrow' until the person reaches age 55 ? This is all 'uncharted territory' !!!

lifetravelergirl
10-26-2013, 04:20 AM
Melonie, I am in one of the "red" states on the map you provided. Which I assume is actually a blue state in real life. But I don't understand the language being used. Declared State-Based Exchange? What does that mean? Based on this map it appears to me as if no state has opted out of Obama care. I am so confused but I am pretty sure I am supposed to be really stressed out about this based upon how angry my father is that I haven't bought insurance I can't afford. I have this thing I like to call debt. 9k credit card debt and mortgage and a fully extended home equity line of credit.

lifetravelergirl
10-26-2013, 04:24 AM
it does mean that you cannot sell these assets, nor pass them on to your children, until Medicaid has been repaid.

Same thing as far as I am concerned.

I rent my house out. It is part of my "business" of being self-employed and I live in a small area of the house that is entirely separate with it's own entrance and exit. Do you have any idea how that might fit into Obama's glorious plan?

Melonie
10-26-2013, 04:29 AM
^^^ the Gray states on the map have opted out of establishing their own state run exchanges ... which also means that they have opted out of setting up Expanded Medicare in their state. Thus for persons with incomes under the 133% FPL level or about $14k per year, Expanded Medicaid won't be available. So in order to qualify for regular Medicaid in those states, people living in those states will have incomes low enough to meet the state's income threshold ( which may only be $6-8-10k per year ) as well as meet the 'asset' test i.e. if you own a home, an expensive car, have more than $2-5k in the bank you don't qualify.

However, since the exchanges in these states will be run by the Federal gov't, insurance coverage sold in these states must follow the same federal standards as the rest of the states ... with eligibility for Public Health Exchange purchases of ( subsidized ) health insurance STARTING at 133% of FPL. For better or worse, this leaves a 'gap' for residents of those states who earn less than 133% of FPL. but who have too much income or too many assets to qualify for the state's regular Medicaid program. Those people who will fall in this 'gap' will either wind up buying UNSUBSIDIZED public health exchange insurance ( at the same monthly premium as those earning more than $46k per year ) or will wind up paying the new ObamaCare penalty of $95 per year while not having health insurance.

Melonie
10-26-2013, 04:33 AM
http://obamacarefacts.com/obamacarefacts-images/public-domain/insurance-exchange/state-health-insurance-exchanges.jpg



^^^ the non-Red states on the map have opted out of establishing their own state run exchanges ... which also means that they have opted out of setting up Expanded Medicare in their state. Thus for persons in those non-Red states with incomes under the 100-133-138% FPL level ( varies by individual state ), Expanded Medicaid won't be available. So in order to qualify for regular Medicaid in those non-Red states, people living in those states will have to have incomes low enough to meet the state's pwn income threshold ( which may only be $6-8-10k per year ) as well as meet the states own 'asset' test i.e. if you own a home, an expensive car, have more than $2-5k in the bank etc., you don't qualify.

However, since the exchanges in these non-Red states will be run by the Federal gov't, insurance coverage sold in these states must follow the same federal standards as the rest of the states ... with eligibility for Public Health Exchange purchases of ( subsidized ) health insurance STARTING at 100% of FPL or about $11k per year. For better or worse, this leaves a 'gap' for residents of those states who earn less than 100% of FPL. but who have too much income or too many assets to qualify for the state's regular Medicaid program. Those people who will fall in this 'gap' will either wind up buying UNSUBSIDIZED public health exchange insurance ( at the same monthly premium as those earning more than $46k per year ) or will wind up paying the new ObamaCare penalty of $95 per year while not having health insurance. The above situation is the unintended consequence of the US Supreme Court ruling that states could not be 'forced' to provide Extended Medicaid coverage, while at the same time the ObamaCare law cuts off Public Health Exchange taxpayer subsidies to reduce insurance premiums below the 100% of FPL level.

(snip)"When the health care law was passed, it required states to provide Medicaid coverage for adults between ages 18 and 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.

It also provides tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Marketplace.

Under the law, the federal government will pay states all of the costs for newly eligible people for the first three years. It will pay no less than 90% of the costs in the future.

The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states are not expanding their Medicaid programs as of January 1, 2014.

Many adults in those states with incomes below 100% of the federal poverty level fall into a gap. Their incomes are too high to get Medicaid under their state’s current rules. But their incomes are too low to qualify for help buying coverage in the Marketplace.(snip) from


To make matters even more confusing, a Federal Court has just allowed a lawsuit to proceed which charges that, under the letter of the new ObamaCare law, the Federal gov't / IRS is NOT allowed to pay for taxpayer subsidies thus reduced cost health insurance premiums for residents of states who have not elected to set up their own state run health care exchanges. If this lawsuit ( or any of the other three pending lawsuits making the same claim ) are successful, it will mean that residents of states which opted not to set up their own state run health care exchanges will be required to pay full price monthly premiums for ObamaCare insurance regardless of their income level. Asking people earning $15-30k per year to pay insurance premiums costing $2-3k per year is obviously unaffordable, thus if the lawsuits are successful low income residents of states that have not elected to set up their own Public Health Care exchanges will essentially be 'exempt' from buying ObamaCare insurance and/or from paying the new IRS penalty !!!

see

(snip)"36 states have decided against opening exchanges for now. Although the law permits the federal government to open exchanges instead, it does not say tax credits may be given to those who buy insurance through a federally run exchange.

Apparently no one noticed this when the long and complicated bill worked its way through the House and Senate. Last year, however, the Internal Revenue Service tried to remedy it by putting out a regulation that redefined "exchange" to include a "federally facilitated exchange." This is "consistent with the language, purpose and structure … of the act as a whole," the Treasury Department said.

But critics of the law have seized on the glitch. They have filed four lawsuits that urge judges to rule the Obama administration must abide by the strict wording of the law, even if doing so dismantles it in nearly two-thirds of the states. And the Obama administration has no hope of repairing the glitch by legislation as long as the Republicans control the House.(snip)



I am in one of the "red" states on the map you provided. Which I assume is actually a blue state in real life

I rent my house out. It is part of my "business" of being self-employed and I live in a small area of the house that is entirely separate with it's own entrance and exit. Do you have any idea how that might fit into Obama's glorious plan?

I would infer the following. Since you live in a state that operates its own Public Health Exchange, and thus provides Expanded Medicaid coverage, if you earn less than 100-133-138% of FPL ( varies with individual states ) you will be signed up for Expanded Medicaid. If your house's property deed is in your name, then it is potentially subject to Medicaid liens equal to the 'cash value' of any medical treatment you receive under Expanded Medicaid plus some annual Medicaid 'administrative costs' for every year you are covered under Expanded Medicaid. If you don't make an attempt to sell the house, those liens will be filed when you reach age 55. If you are signed up for Medicaid, and if you do attempt to sell the house, odds are that those liens will be filed at the time of the property sale rather than waiting until you reach age 55.

However, if you move quickly, it may be possible for you to set up your own real estate LLC / S-Corp and transfer the house you own to that new corporation BEFORE you sign up for Expanded Medicaid. The corporation would then pay you a 'salary' for administering the property / rentals. Doing this would arguably leave you without the house as a personal asset, but would leave you instead with the LLC / S-Corp shares as a different personal asset. It may be more difficult for the state to limit the corporation's ability to sell the house. But upon your death the state could still seize the house via seizing your corporation shares. On the other hand, it may be possible for you to 'sell' your corporation shares ( and thus the house ) to a child at an extremely reduced price level, effectively making an 'end run' around Medicaid.

It would appear that the only way that you can totally avoid risk of Medicaid eventually seizing your house to repay health care expenses incurred under Medicaid is to somehow increase your reported income 1$ above the 100-133-138% of FPL level ( varies by particular state ). At that income level, you become eligible to purchase Public Health Exchange health insurance coverage with LARGE taxpayer subsidies, or you become eligible to elect NOT to purchase Public Health Exchange health insurance coverage and pay the penalty instead ( which may or may not actually be collectable, depending on how you tax withholding is set up ). Unlike Expanded Medicaid, the Public Health Exchange coverage is 'real' health insurance, meaning that any medical care costs paid for by ObamaCare insurance cannot be recovered from you later.

Since signing up for ObamaCare insurance, at least so far, does NOT require an income verification, technically speaking there is nothing to stop you from claiming to have a $11k-$15k annual income i.e. 101-134-139% of FPL ( depends on particular state ) at the time of signup ... and thus avoiding being steered to Expanded Medicaid ... for the first year. However, part of the Washington budget impasse 'deal' included an ObamaCare income verification requirement, such that your actual reported income is likely to be checked against IRS records when it comes time to sign up for ObamaCare insurance again a year from now. However, this would 'buy' you a year during which you can figure out how to increase your income to 101-134-139% of the FPL ( again varies by particular state ) and thus avoid eventually 'losing' your house to Medicaid.

IMHO there is something very 'unfair' about being able to earn a couple of extra thousand dollars per year ... thus being able to exceed the 100-133-138% of FPL level for ObamaCare insurance eligibility versus being steered toward Expanded Medicaid ... and in the process avoid 'losing' a house you own which may be worth $100,000+ to Medicaid. But the ObamaCare rules are what they are. Thus low income persons who own assets like houses now have a strong incentive to increase their incomes in order to 'keep' those assets, while low income persons who do NOT own assets have a strong DIS-incentive to increase their incomes and acquire assets ( since doing so would not actually result in any 'net' gain ... well, at age 55 anyhow ).

lifetravelergirl
10-26-2013, 06:08 AM
Thanks Obama.

Isn't there an online company that will help you with legal paperwork such as creating an S Corporation affordably? Thank you Melonie, you are awesome :) !

Melonie
10-26-2013, 06:15 AM
^^^ yes, lots of them. However, to transfer the property deed, you'll definitely need an attorney ... so you might as well leave forming the corporation to the same attorney !!!

Note that since there is no 'precedent' to go on at this early point in Expanded Medicaid's existance, my idea about transferring your house to a corporation may not actually 'fly' when it comes to a state Medicaid dep't attempting to place a lien on the property if you are the sole owner of the corporation. It may also make a difference if that new corporation is registered in the same state you reside in, versus being registered in a different state that does NOT offer Expanded Medicaid !!! And beyond that, there may also be an issue of 'capital gains' taxes coming due upon the transfer of the property that you might have to pay out of pocket in order to effect the transfer. Thus the best 'first step' I can recommend is consulting with a local attorney about this matter before doing anything else.

Increasing your income to the 101-134-139% of FPL level ( depending on your particular state's Expanded Medicaid eligibility rules ), however, is guaranteed to avoid the Expanded Medicaid problem of future 'loss' of your house ( as well as the legal fees and 'capital gains' taxes ). In the final analysis, this may be your least 'expensive' option. Got a webcam ???

Nina_
10-26-2013, 07:37 AM
I'm calling shenanigans on your post (quoted above).

You are aware that clubs don't provide health insurance like other jobs do, right? If the Affordable Care Act "goes under", a lot of people with preexisting conditions, with unconventional/freelance/independent jobs, and part time jobs could face serious financial hardship if they are not covered and end up sick or injured. Why would you advise someone risk their health and finances to make a point?

Yup. My cousin is now a med student at U of M, and when she was 5 she had leukemia. Obviously due to her preexisting condition, insurance companies have seen her as a 'risk' since then. So obviously she and my aunt (her mom) are very much in favor of Obama Care!

lifetravelergirl
10-26-2013, 11:58 AM
How difficult do you suppose it would be for me to move to Europe? It seems like the money you pay in taxes there actually buys you something whereas here it's all just a big game to liberate people from their property. Obama care is making me sick and ruining my ability to work because I am so stressed. But the good news is that as someone who takes very good care of myself I will be paying the medical expenses of others, medical expenses I won't be able to afford to take advantage of. What a fantastic country we live in. I hope they take away more of my freedoms and tax me some more, maybe even offer greater incentives to send jobs overseas, that would be awesome. Who is going to pay for all the drones and illegal wire tapping? Maybe we need a new tax. I'm sure glad I don't live in a communist country, America, fuck ya!

http://www.youtube.com/watch?v=IhnUgAaea4M

Jasmine.Doll
10-26-2013, 12:07 PM
Depends on the country. I'm absolutely NOT an expert, but I do know that work visas are generally tough to get. You need to have a job set up b4 you go (Unless you go on a 90 day max travelers VISA, I think). Most of the jobs you get will be set for a specific amount of time and its very hard to get work VISAs extended. I assume it would depend on the job. If you had some kind of much needed expertise in a specific field, it would be easier to stay longer. Citizenship is a bitch to receive in Europe. I tried to move to Denmark, once. It did not work out.

lifetravelergirl
10-26-2013, 12:09 PM
I am looking at Norway or the Netherlands. I have a friend in Norway and I can stay with her. I was planning on camming and selling clips and writing stories for sale.

Jasmine.Doll
10-26-2013, 12:12 PM
Maybe! I really don't know. It is illegal to work with a travelers VISA, so I don't know how that would affect camming and whatnot. But, it would def be cool to move to Norway!

Melonie
10-26-2013, 03:02 PM
Yup. My cousin is now a med student at U of M, and when she was 5 she had leukemia. Obviously due to her preexisting condition, insurance companies have seen her as a 'risk' since then. So obviously she and my aunt (her mom) are very much in favor of Obama Care!

I hope that your cousin and aunt are still happy with ObamaCare after your cousin graduates with an M.D. !!! Reportedly, she is unlikely to be able to set up her own practice due to the lower future Medicaid and Medicare reimbursement rates resulting from ObamaCare making a new private practice unprofitable. Reportedly, she'll wind up competing for a job as an 'employee' doctor of a large hospital or medical group ... as lower ObamaCare reimbursement rates force more and more medical care to be 'handed down' to lower pay rate nurse practitioners and physician's assistants so that the large hospital or medical group can avoid financial losses. From

(snip)"Even before the ACA's launch in 2013, many physicians—seeing the changes in their profession that lay ahead—had begun talking their children out of going to medical school. After the launch, compensation fell, while nothing in the ACA stopped lawsuits and malpractice premiums from rising. Doctors must now see many more patients each day to meet expenses, all while dealing with the mountains of paperwork mandated by the health-care law.(snip)

(snip)Medicaid in 2016 has similar problems. A third of physicians refused to accept new Medicaid patients in 2013, and with Medicaid's expansion and government cuts, the numbers of doctors who don't take Medicaid skyrocketed. The uninsured poor now have insurance, but they can't find a doctor, so essentially the ACA was of no help.

The loss of private practice is another big problem. Because of regulations and other government disincentives to self employment, doctors began working for hospitals in the early 2000s, leaving less than half in private practice by 2013. The ACA rapidly accelerated this trend, so that now very few private practices remain.

When doctors are employed like factory workers by hospitals, data from the Medical Group Management Association and others indicate, their productivity falls—sometimes by more than 25%. They see fewer patients and perform fewer timely procedures, exacerbating the troubles caused by physician shortages. Continuity of care also declines, since now a physician's responsibilities end when his shift is over.(snip)

(snip)With an average of $300,000 in student loans, eight years of college and medical school, and three to seven years as underpaid, overworked residents, a prospective physician in the ACA era would be starting a career at age 30 in a job that requires working 70-80 hours a week in an assembly-line fashion to earn perhaps $100,000 a year. No wonder so many qualified individuals these days are choosing careers on Wall Street or in Silicon Valley instead of medicine."(snip)

Jasmine.Doll
10-26-2013, 03:23 PM
^^I'd be interested in seeing these reports because I'll be an APRN soon and am always hearing different things. But, I seriously don't want my own practice. I don't know many docs who do either. Malpractice insurance is a bitch and its nice to have a hospital cover that for u... I don't see how new MDs will be "competing" for work. Everything I've read and heard predicts a major shortage of APRNs, RNs, MDs, etc. Now that everyone will be able to get preventative healthcare, clinics and hospitals are going to be freaking busy!!!

My cousin just got his MD and hospitals are fighting over him, even though he just barely finished his residency. He is worried that Medicaid is going to force him to see 5 bazillion patients a day and pay him the same as they would for only seeing 1 bazillions. I dunno. I just moved to MA and it is the most insured state in the county. Something like 96% of the state has health insurance. It is HARD to get into see a doc in Boston, which is nuts because there are more docs in Boston, per capita, than anywhere else in the country. I think shit will be crazy for awhile, but hopefully better in the long run. It sucks not to be able to see a doc when you need to.

I understand why people are wary. I read today that when Medicare went into affect, only 18% of the US population was into it. Now everyone's all like, "Take my Medicare out of my cold, dead hands!!!" There are parts of the plan I like about regulating medical equipment costs (the hospital I'm at now charges $75 for a yard of paper tape!!!), covering people with preexisting conditions, not letting insurance companies drop you for getting sick, etc. But I do wonder how smoothly (or not) the implementation of Obamacare will go. It seems like its going well in some states (CA) and really terribly in others (TX).

Jasmine.Doll
10-26-2013, 03:27 PM
Oh. There's a link there. Was that there b4? I think I'm going crazy. Thx!!

Smurfette
10-26-2013, 03:43 PM
How difficult do you suppose it would be for me to move to Europe? It seems like the money you pay in taxes there actually buys you something whereas here it's all just a big game to liberate people from their property. Obama care is making me sick and ruining my ability to work because I am so stressed. But the good news is that as someone who takes very good care of myself I will be paying the medical expenses of others, medical expenses I won't be able to afford to take advantage of. What a fantastic country we live in. I hope they take away more of my freedoms and tax me some more, maybe even offer greater incentives to send jobs overseas, that would be awesome. Who is going to pay for all the drones and illegal wire tapping? Maybe we need a new tax. I'm sure glad I don't live in a communist country, America, fuck ya!

http://www.youtube.com/watch?v=IhnUgAaea4M

I hate to break it to you but there is no where in the world more libertarian than the USA (at least not in the first world). Anywhere you go in Europe will be WAY more socialist. Especially the Scandinavian countries! LOL.

Melonie
10-26-2013, 03:53 PM
I am looking at Norway or the Netherlands. I have a friend in Norway and I can stay with her. I was planning on camming and selling clips and writing stories for sale.


Note that unlike the USA, Norway ( and most other western European countries ) only provide social benefits for citizens / legal residents.

(snip)"When you first come to Norway you will probably not be a resident of Norway nor a member of the National Insurance Scheme. All persons that are not permanent residents of Norway are personally responsible to compensate/pay for any and all medical attention received. As a non-resident you will have to pay full price for either."(snip) from

Also, Norway collects a specific tax that you won't like if you are planning on camming ... the national tax on remuneration to non-resident artistes (skatt til staten på honorar til utenlandske artister)

I'm just trying to point out that 'the grass isn't always greener'. I personally 'searched' long and hard before deciding to ex-patriate to a particular country 'way south of the border', based on ability to become a legal resident / citizen, ability to legally avoid / minimize both taxes imposed by the 'new' country as well as taxes still being due to the US IRS, access to affordable high quality medical care, local cost of living, personal safety / stability, etc.

Melonie
10-26-2013, 04:00 PM
My cousin just got his MD and hospitals are fighting over him, even though he just barely finished his residency. He is worried that Medicaid is going to force him to see 5 bazillion patients a day and pay him the same as they would for only seeing 1 bazillions. I dunno.

Trying to stay 100% on the financial side, given lower ACA reimbursement rates, the hospitals and clinics will only be able to afford to pay MD's ( and other health professionals ) X dollars while still remaining 'solvent'. Based on previous experience in the UK and other countries, this is likely to create a competition where US educated doctors will wind up receiving employment offers up to that X dollar level, after which the hospitals and clinics will reach out to H1B visa holding MD's from Pakistan, Armenia etc. who are willing to accept the X dollar pay offer rather than the hospital or clinic being 'forced' to offer US educated doctors more than pay rate X. This by definition removes any 'leverage' that US educated doctors might have had in the past, despite the fact that US educated doctors face huge student loan debts that Pakistani, Armenian etc. doctors do not !!!


Granted that SOME US educated doctors may have an alternate 'career path' available within the rapidly growing sub-segment of so-called 'Concierge Medicine'. This approach essentially rejects patients with Medicare, Medicaid, ObamaCare, and 'other' private insurance, in favor of only accepting patients who are willing and able to pay 'cash' for both an annual retainer as well as pay 'cash' for medical treatments. Obviously, only a small percentage of Americans will be able to afford this 'higher tier' of medical care, meaning that only a small percentage of doctors will be able to work within this 'career path'. As to what sort of criteria will be used to select which doctors will be able to join 'Concierge Medicine' practices, that remains to be seen. However, given the upscale nature of the clientele, it is likely that a medical degree from an Ivy League medical school and/or other upscale factors in the doctor's personal background will be important considerations.

Jasmine.Doll
10-26-2013, 04:12 PM
Money is SO not my thing. I have read nothing about what I'm about to say, just to make that clear. But won't all the people who are now paying for medical insurance for healthcare with better controlled costs create some $ to pay medical professionals with? Like I said, I have no evidence to back this up. It just makes sense in my head (as do a lot of things that don't actually make sense.)

I don't know how effective the new student loan programs are on a widespread scale, but there are a number of ways to get your RN or MD or whatever paid for. You just have to give away 3 years of your life to providing service (for pay) in a deprived area. That's what I'm doing. Super excited cuz I've got some serious student loan debt piling up!!

Melonie
10-26-2013, 04:19 PM
But won't all the people who are now paying for medical insurance for healthcare with better controlled costs create some $ to pay medical professionals with?

Again, strictly on the financial side, the amount of money that a doctor or other health care professional is able to earn ( with the doctor's practice or 'employer' hospital or clinic still remaining in the 'black' ) is a function of how many patients the doctor can see ( actually, bill ) as well as how much the doctor will be paid per patient seen ( actually, billed ). ObamaCare dictates that 'reimbursement' levels paid to doctors seeing patients covered under Medicare, Medicaid, and also patients with lower level ObamaCare insurance coverage ( which involves only certain health care provider networks that are willing to accept low pre-negotiated 'reimbursement' levels ), will all decline. So by definition this will translate into doctors waseeing more patients per day, or doctors being paid less money, or both !!!



Everything I've read and heard predicts a major shortage of APRNs, RNs, MDs, etc.

Yes there is likely to be a future shortage of such medical professionals. But some pundits point out that one reason for this shortage will be the poor 'financial equation' of investing huge amounts of time and tuition money to obtain the necessary credentials, versus working for 'reduced' future pay rates and/or working much harder for the same pay rate. You may want to re-read an earlier story I posted where present day doctors have been advising their children NOT to follow their footsteps into a medical career, versus going into a Wall St. or Silicon Valley career instead.



I don't know how effective the new student loan programs are on a widespread scale, but there are a number of ways to get your RN or MD or whatever paid for. You just have to give away 3 years of your life to providing service (for pay) in a deprived area. That's what I'm doing. Super excited cuz I've got some serious student loan debt piling up!!

Again, strictly on the financial side, laws have recently been passed that will 'pay off' ( via US taxpayer 'losses' on student loan debt ) the outstanding balance of any student loans for people who work continuously in 'public service' for a 10 year period. This undoubtedly includes work at gov't run hospitals, clinics and other health care facilities ( like state prisons ). Also, because student loan 'forgiveness' becomes a major financial factor ( i.e. $300,000 of a doctor's student loan debt being forgiven after 10 years equals a de-facto $30k per year in extra 'income' ), 'public service' health care facilities are likely to be able to offer even lower pay rates for doctors and still receive an adequate number of new applicants !!!

Also, there may be particular situations where a given health care institution may contract with a 'future' health care professional to underwrite their educational cost in exchange for X years worth of 'involuntary servitude' after graduation. However, applying a little bit of 'common sense', there has to be a reason that the health care institution would be willing to make such a significant investment versus simply offering to hire a health care professional directly ... i.e. thoughts of working 6 month stretches on the north slope of Alaska, 1500ft underground in a coal mine etc. come to mind.

xxxGothBarbie
10-26-2013, 04:47 PM
this whole thing will eventually die off bc not only is it fucking the country , many people are gonna use their smarts & evade it like myself. I have nothing they could take. I don't ever get sick & besides if I did there are always other methods of treating yourself aside from going to the DR. I'm just gonna sit back & laugh at this crap

Jasmine.Doll
10-26-2013, 04:58 PM
^^Nothing to do with Obamacare, but it can be hard to predict when you might need medical care. Car wrecks happen, cancer happens, I don't know if you want kids eventually, but if you do you probably won't wanna deliver it yourself. Look at Japan! Those folks in Fukushima did not see that shit coming. But you are right, most health problems are totally avoidable by taking care of yourself. And if something awful were to happen, you'll still be able to get care, anyway. I totally get why you feel very unthreatened. I am and have been in debt up to my eyeballs for years and it has not been a big deal. I'm a cash enterprise and don't have anything they could take, either.

xxxGothBarbie
10-26-2013, 05:05 PM
^ yup :) & fyi hell no I do not plan on ever having kids. I don't like them lol

Melonie
10-26-2013, 05:10 PM
I totally get why you feel very unthreatened. I am and have been in debt up to my eyeballs for years and it has not been a big deal. I'm a cash enterprise and don't have anything they could take, either.


^^^ and therein lies the 'bottom line'. From a financial standpoint, the ObamaCare rules and consequences indeed create a situation where personal debt is preferable to personal assets, where the cost 'risk' of an unhealthy / risky lifestyle is passed on to others while a healthy / low risk lifestyle goes 'unrewarded', and where a strong incentive exists to minimize 'reported' income and 'visible' asset levels.

However, the strong incentive to minimize 'reported' income and 'visible' assets was not lost on the US congress. As part of ObamaCare they approved funding for the IRS to hire 16,000 additional auditors - essentially doubling the IRS' capacity to perform audits. Undoubtedly, those new auditors will be targeting the most 'fertile' territories for increased tax / ObamaCare premium collections, with those working in 'cash' businesses probably being at the top of their list. See

Melonie
10-26-2013, 09:24 PM
... and CBS news just released these ObamaCare signup statistics ... or should I say Medicaid signup statistics ... from


(snip)"(CBS News) The disastrous rollout of HealthCare.gov may have another serious problem: A CBS News analysis shows that in many of the 15 state-based health insurance exchanges more people are enrolling in Medicaid rather than buying private health insurance. And if that trend continues, there's concern there won't be enough healthy people buying health insurance for the system to work.

As the Obamacare website struggles, the administration is emphasizing state-level success. President Obama said Monday, "There's great demand at the state level as well. Because there are a bunch of states running their own marketplaces."

But left unsaid in the president's remarks: the newly insured in some of those states are overwhelmingly low-income people signing up for Medicaid at no cost to them.

Matt Salo, executive director of the National Association of Medicaid Directors, said, "We're seeing a huge spike in terms of Medicaid enrollments."

He says the numbers have surprised him and state officials.

CBS News has confirmed that in Washington, of the more than 35,000 people newly enrolled, 87 percent signed up for Medicaid. In Kentucky, out of 26,000 new enrollments, 82 percent are in Medicaid. And in New York, of 37,000 enrollments, Medicaid accounts for 64 percent. And there are similar stories across the country in nearly half of the states that run their own exchanges.

Medicaid experts say they're not sure why they're seeing the lopsided enrollment numbers"(snip)

miabella
10-26-2013, 10:41 PM
I haven't read the whole thread, but some quick points:
--Income only is assessed for "exchange" subsidies. Trustafarians can get subsidies, people with fluctuating occasionally high annual income, not so much. They haven't decided whether to count things like child support yet, for sure.

--The subsidies come in two flavors, premium and out of pocket. The out of pocket subsidies only happen if you buy "silver" plans *and* have income show up as less than 250% of the federal poverty level, but you can get premium subsidies at 400% of that level and on any color of plan. However, the premium subsidies are based on the silver plans, so any other colors, you basically get less subsidy.

--Because the insurance costs can be taken out of your tax refund, anyone relying on their big tax refund will have to choose between 10k child credit/etc refund and 10k 'exchange subsidy'. You can't get both, the tax system isn't structured for it to happen.

--Even though most Americans don't have to mess with the exchanges, the exchange plan baseline is what employer-based insurance is shifting to, if you have a straight job with insurance and dance for extra money. This is really sticking those of us with small businesses in a difficult place. I sit up a lot running numbers these days and wondering just how bad it would be to go barter. We shall see!

--concierge care is increasing, which is prepaying in cash instead of via an insurance policy. could be a good option going forward, as it's very sheltered in terms of paperwork and requirements on the doctor's end and cheaper on the patient's end and there is the possibility of the same HUGE group discounts the Amish get if you do get cancer or something else big.

sorry if these have been covered already, but these just jumped out as some things that are happening that aren't quite obvious from the news articles about obamacare.

lifetravelergirl
10-26-2013, 11:25 PM
I hate to break it to you but there is no where in the world more libertarian than the USA (at least not in the first world). Anywhere you go in Europe will be WAY more socialist. Especially the Scandinavian countries! LOL.

Yes I am fairly confident of that however it seems that in Norway your taxes actually return some benefits. They seem to have a more efficient system.

miabella
10-26-2013, 11:54 PM
They also have a lot fewer people.

eagle2
10-27-2013, 01:53 AM
I hope that your cousin and aunt are still happy with ObamaCare after your cousin graduates with an M.D. !!! Reportedly, she is unlikely to be able to set up her own practice due to the lower future Medicaid and Medicare reimbursement rates resulting from ObamaCare making a new private practice unprofitable. Reportedly, she'll wind up competing for a job as an 'employee' doctor of a large hospital or medical group ... as lower ObamaCare reimbursement rates force more and more medical care to be 'handed down' to lower pay rate nurse practitioners and physician's assistants so that the large hospital or medical group can avoid financial losses. From http://online.wsj.com/news/articles/SB10001424052702303448104579149642030106938

(snip)"Even before the ACA's launch in 2013, many physicians—seeing the changes in their profession that lay ahead—had begun talking their children out of going to medical school. After the launch, compensation fell, while nothing in the ACA stopped lawsuits and malpractice premiums from rising. Doctors must now see many more patients each day to meet expenses, all while dealing with the mountains of paperwork mandated by the health-care law.(snip)

(snip)Medicaid in 2016 has similar problems. A third of physicians refused to accept new Medicaid patients in 2013, and with Medicaid's expansion and government cuts, the numbers of doctors who don't take Medicaid skyrocketed. The uninsured poor now have insurance, but they can't find a doctor, so essentially the ACA was of no help.

The loss of private practice is another big problem. Because of regulations and other government disincentives to self employment, doctors began working for hospitals in the early 2000s, leaving less than half in private practice by 2013. The ACA rapidly accelerated this trend, so that now very few private practices remain.

When doctors are employed like factory workers by hospitals, data from the Medical Group Management Association and others indicate, their productivity falls—sometimes by more than 25%. They see fewer patients and perform fewer timely procedures, exacerbating the troubles caused by physician shortages. Continuity of care also declines, since now a physician's responsibilities end when his shift is over.(snip)

(snip)With an average of $300,000 in student loans, eight years of college and medical school, and three to seven years as underpaid, overworked residents, a prospective physician in the ACA era would be starting a career at age 30 in a job that requires working 70-80 hours a week in an assembly-line fashion to earn perhaps $100,000 a year. No wonder so many qualified individuals these days are choosing careers on Wall Street or in Silicon Valley instead of medicine."(snip)

From:
http://www.medscape.com/viewarticle/809357_2
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Dr. Cain said that coverage through the exchanges and the Medicaid expansion will be a boon for family physicians, who see an average of 8 patients a week on a discounted or free basis. "This new coverage will mean that family physicians can have a financially viable practice," he said.
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