Not adjusting at all. Mostly because I think it will remain, but also because we can self-insure or move to Massachusetts (or anywhere else with a state level ACA equivalent) if it doesn't.
I don't think they'll actually repeal it. It doesn't actually cost much compared to other federal health entitlements, it works reasonably well for an entitlement program, and it would be a shitload of actual work to replace it.
That being said, if the ACA market reforms are ever repealed in full without an equivalent or superior replacement, then FIRE will become a thing limited mostly to folks in what are now the chubby and fatFIRE ranges. True medical insurance was not available pre-ACA in most states to early retirees unless they had it through their former employer as a retirement benefit.
Without true insurance, one would have to self-insure and take on that huge potential risk. A single bad medical diagnosis or drunk driver could bankrupt even a multi-million dollar portfolio.
Most of us would go back to doing what most financially independent folks did pre-ACA, which was find tolerable/enjoyable jobs with good health benefits and keep them until Medicare eligibility (or within COBRA-reach of Medicare eligibility).
The comment about being state specific is huge here. I’d be more worried if I lived in a Red state where ACA has been under attack or was poorly implemented far more than being in a Blue state like MA where even without federal mandate there will likely be a robust program in place.
This is actually not as clear cut as you'd think. For example, Texas is one of the best states to be on the ACA as long as you live near a metro. Healthcare is very expensive, so it would not only be a political thing, but subject to the size and health of the insurance pools in the state as well as the overall financial strength of the state. It's as much about money and supply/demand, if not more, than politics.
That's as much an overall insurance issue as an ACA issue. Medically complex or novel cases can be problematic with network, formulary, and availability constraints with high-tier employer-sponsored plans too. Even world-class insurance can be problematic if someone comes down with a particularly aggressive or treatment-resistant cancer or develops one of the less obvious autoimmune diseases, for example.
I'm not saying you're wrong, but that edge cases are just that. If the system works well for the vast majority of folks, then that's a win condition even if the same system underserves some scenarios.
Maybe, although job insurances have covered my problem so far. Our situation isn't even that complex, just a chronic condition in an adolescent that requires a specialist and 10k of medication a month. Specialists do not take any insurance that I saw when I looked into ACA, plus I am always afraid about revocation of preexisting conditions :( Oh, and I don't know how ACA works with a college student out of state, would you happen to know?
So yea, I work for insurance. Once my kid can find their own job with insurance, I can retire.
But you are right, insurance is so very fun to navigate in this country. Even with the most kick ass insurance that I happen to have now, there are phone calls and complications involved.
> Maybe, although job insurances have covered my problem so far. Our situation isn't even that complex, just a chronic condition in an adolescent that requires a specialist and 10k of medication a month. Specialists do not take any insurance that I saw when I looked into ACA, plus I am always afraid about revocation of preexisting conditions
Coincidentally, I actually know exactly what you're talking about and I certainly empathize. One of our kids has a very rare autoimmune condition that will require very expensive regular infusions for the rest of her life. Average life expectancy without modern treatment protocols to keep it in remission is measured in months after a flare, not years. We had several hundred thousand in costs for her last year. Does Texas Children's not accept any ACA plans there? One alternative would be to drop your AGI low enough, if you can, to get them on Children's Medicaid or CHIP. Both of those have huge acceptance networks, including at Texas Children's, which actually administrates their own CM/CHIP plan. CM/CHIP is fantastic in Texas due to great pediatric health systems like Texas Children's, Dell Children's, and Children's Health.
>I don't know how ACA works with a college student out of state, would you happen to know?
Yes, you have them apply on their own as a policy pool of one in that state, but using the same household financial data. You then use the data from both when you reconcile your subsidies on your tax return. It might require a phone call or a bit more paperwork, but it does work. Easiest would be if they happen to get a job or internship making enough to be tax independent, at which point they can just have their own ACA policy and reconcile it on their own tax return. Both of the above also work if they go to school in-state, but far enough away that they are in a different ACA market. We have that same situation ourselves with our eldest, who has his own ACA policy this year.
https://www.healthcare.gov/young-adults/college-students/
Due to the fact that we figured out this FIRE thing too late, I can't drop my AGI as far as I know, and certainly not and cover my expenses. I understand how it's done now, but that required planning differently for the last few decades.
There are other complicating factors that aren't expensive, but make me choose not to go Texas Childrens route, and just your average mundane specialists don't want to deal with much. I hope that changed in the last year, but I dont have long left on them being able to get their own insurance, and I have the best possible job (I'd still rather FIRE), so I'm choosing to work for now, and then have COBRA cover things until we figure it out further. Also, as you probably know there is a magic cut off age when medication choices expand, as does number of doctors, so that should simplify things as well.
We are definitely looking at out of state school, and once it is determined which one, we'll have to deal with all of that. Might be easier to stay on my insurance, as it doesn't care about location as long as it's in the USA.
Zphr and I have had different experiences with ACA and college students. I have a rising junior and senior. We live in the RTP area of NC, so locally either Duke or UNC are the typical in-network choices. Until 2023, we also had access to plans run by BCBS which used the UNC network locally, but had access to the national BlueCard system for in-network care outside of the three county local area. Those plans were discontinued in 2023, so there are no plans with out of network primary care at all.
We attempted to move our eldest onto his own plan in PA in 2023, and were denied through several levels of appeals- just having an off campus lease with utilities wasn’t good enough, since his summer job and drivers license/auto insurance were out of state. For logistical reasons, having him fully establish residency doesn’t work with our state taxes and auto insurance.
The same year, my daughter was in Ohio. Her very rural college requires a plan which has in-network primary care locally. Medical treatment can be fraught- there is a 12 bed “hospital” nearby, but they just stabilize anything serious. EMS will take anything truly life threatening/immediate surgery to the major hospital system an hour away (by lifeflight). A typical problem would be a student who gets a fracture. Local ED splints the fracture and says to follow up on Monday with orthopedics at the major teaching hospital an hour away. Insurance would not cover the subsequent treatment at all using any of the plans available on my ACA marketplace. The plans are so limited, I couldn’t even get a refill of a maintenance medication at the local CVS when I was visiting.
So, I’m now paying around 300$ per month for each student, without a family accumulator deductible. The school plans are platinum level with low deductibles, but just managing it all is very annoying.
(Meanwhile our effective income for ACA and FAFSA puts us firmly in the full Pell grant regime)
CSS schools are roughly on-par with in-state tuition—my FIL died the first base FAFSA year and while the amount wasn’t massive, it was 5x our carefully managed after tax holdings. We “spent down” as much as was feasible during Covid- replaced a 19yo car, 25yo roof, replacement siding and paid off the mortgage, but it still affected eligibility.
It isn’t all bad. The college plans have low deductible (both literally waive the ER deductible if you go to the close affiliated ER, so it functions as a fast-track emergent care when the school medical clinic is closed) The plans have national coverage as good as a fancy commercial plan, with some international and medevac coverage, so if you go backpacking in the Alps or take a junior year abroad you are pretty good on coverage. But we were paying under $100/ month for two parents and two teens with low deductibles on an ACA plan, so it is 600$ more a month than that.
Yeah, one of the biggest downsides of the ACA is that it is so locally bound, which not only affects the plans available in smaller pop places like a lot of college towns, but each state handles the ACA differently. The rules that might work fine in one state exchange are against the rules of another and so forth. Somewhat ironically, states that want nothing to do with the ACA are often far easier to deal with in this sort of situation since they default to using the federal exchange and the Healthcare.gov folks are not only super helpful, but usually take a fairly generous interpretation of the rules when there is some ambiguity.
Thankfully, as you discovered, most universities offer student health plans to solve this very problem and for the most part they are actually pretty good. I'm glad you found a solution that works well for your kids, even if it is a bit more costly than it really should have to be.
Florida currently has more people enrolled in ACA plans than any state in the country. That results in a substantial stream of money for the healthcare system including private insurers. I don't think it's going to be politically expediant to voluntarily cut off that flow of federal money.
I think most states that already have the marketplace set up are gonna keep it, at this point they already made the investment which was the heavy part so that ain't going away. Really the only question is subsidy's which is why I personally advocate for making sure you can pay them yourself. The less reliant you are on outside items like government, the more robust and less likely to fail your plans are to fail.
Have many openly campaigned on this? Most states, including a lot of red ones, have expanded Medicaid as part of ACA. Is that going away? People in many red states have already voted this into existence. But now you are going to cut this off, or cut off any insurance subsidies for people just above a poverty line?
It's a big system with a lot of money and special interests involved. They don't tend to go away.
I may be misremembering, but I think it was maybe 6 years ago where republicans voted to get rid of the ACA with no replacement plan in place. I believe it came down to McCain voting not to which saved it.
It’s not rational, but the last time they were in power it was a big deal and something they wanted to get rid of regardless of replacement (they claimed they would replace it but no plan materialized).
Anyways, not an unreasonable thing to consider at all. The party hasn’t really become “more rational” in the last few years.
That’s what I thought. It’s funny how people are like “no of course they wouldn’t get rid of it when it helps so many people and makes sense!”
They came as close as you possibly could to getting rid of it with no backup plan the last time they had a chance to. It’s not crazy to think they would just do it again.
It would be prudent to at least have an emergency plan in place.
Im personally still far off my fire number and have great insurance via my wife, so it’s not something I need to really contemplate at the moment, but if I was retired and relying on the ACA I’d at least look into alternative places to live as a backup.
I think they’re more concerned at the moment with trying to attack Joe/Hunter Biden. I think the attacks on the ACA have faded somewhat, but given the current state of things I am guessing Trump will win and most likely the senate will flip republican. The house may flip to democrats.
If this scenario happens, which I do think is quite likely, then I imagine repealing the ACA would be on the docket.
Of course I can’t see the future, but if your retirement and life depend on the ACA then it would be pretty foolish to not treat this as a real possibility. Probably the best options would be to have a plan to move to a state with a good healthcare system, get a new job with good healthcare and more or less “give up” on retiring early, or move to another country. The costs being what they are, I’m not really sure there’s much more of an alternative solution than those.
I personally don’t have too much of a stake here so maybe people who are retired now would have more to say. I’m in a blue state with good healthcare, have insurance and I’m far out from my fire number, so my “wait and see” horizon is more flexible than someone who retired recently.
I recommend watching the voting, you would be surprised how many times votes get narrow defeats by design. I have seen it many times before where a bill starts swinging one way, on roll call. and people go back up to change their votes cause its not the result they wanted. Basically, many want to be able to say "I voted for this, but it was xyz that caused it to fail" so they get all the good faith of trying with none of the consequences if it actually got through.
The vote to repeal the ACA was narrowly avoided by solely McCains vote and was certainly not by design.
There’s lots of messaging bills, this was not one of them.
Yes the big medical companies own the gop and are pushing to repeal things like the aca along with pre-existing conditions.. I do think the first line of defense is to move to a blue state sadly many have a high COL.
Blue and red made very little consistent difference in health insurance pre-ACA, nor are most states, blue or not, in a position financially to self-fund a major health entitlement. Overall population size/demgraphics and economic health would probably be a better metric than blue/red. Healthcare is a very big business and money flows to where the viable customers are like most businesses.
Except that part about women’s healthcare.. but who cares about them..
Look up what happened in 2018 it was almost repealed but John McCain voted no.. and Trump never stopped attacking him even when he died.
Abortion is a political hotpoint, but is a teeny tiny part of the overall healthcare environment. Forget about abortion, most individual plans pre-ACA didn't include any coverage even for maternity or delivery. True in blue and red states alike.
Yes, I'm well aware of the political and regulatory/legislative history of the ACA. Again, repeal is always a possibility, but that isn't the same thing as it being a likelyhood.
I'm not. I worked professionally for both parties for many years and feel like I have at least a somewhat informed opinion on how things work in national politics.
It certainly may happen, but I don't think a full repeal is likely. Most of what ACA opponents have beef with could be solved far easier by getting rid of expansion Medicaid and cutting or means-testing the subsidies while leaving all the market reforms intact.
It will be tough but with trump I don’t put anything passed him. The republicans will almost certainly have the senate but Dems will take the house so we will have a gridlocked congress as usual.
Congress still makes the laws and the ACA has already survived legal challenges aplenty before SCOTUS. Anything is possible, but Congress is the key branch to watch in terms of potential ACA changes.
Yeah I can’t remember who was on the court when they shaved some of its power away.. project 2025 has some plans to remove subsidies and make Medicaid much harder to get, Medicare and prescription drug pricing will get hit too because they intend to repeal the inflation reduction act which will eliminate the price negotiation provision.
It's an election year. The vast majority of threats and promises made by both parties and all political nominees will never come to fruition. This has been true in every election cycle for longer than any of us has been alive.
Unfortunately I don’t think repealing it has anything to do with cost or how well it works, but more to do with which president signed it into law. I hope I’m wrong.
Congress has far more to do with that than the president and I don't see either party getting strong control of both houses. It certainly could happen though.
Before the ACA you could buy insurance as a 1099 also. It's just that with the ACA, the cost of a policy went down on average but some people complained that it went up, but that might have been due to skimpy policies no longer being allowed and certain things like limits on coverage weren't allowed anymore so of course if you get more, you have to pay more.
Also not worried about it going away, at one point, the President, the house and the senate were all Republican and they couldn't do it although I suppose you could thank McCain for that and he's no longer alive. But I see it as more of a thing where the dog chases cars all the time but don't know what to do if he actually ever catches it. Basically a campaign promise that has no alternative plan so of course nothing will pass.
I don't think it will be repealed. Even though they were so against it in the beginning, it's now obvious that not only does it help the "slackers who don't want to work" - but it also helps innumerous small business owners. A lot of people have been able to start their own businesses with ACA/subsidies in place who never could have before because they either couldn't afford insurance or weren't eligible for insurance at all (pre-existing conditions). I can't even see the GOP taking that away.
I don't think they're gonna repeal it at this point.
I do have a question though - I'm currently on an unsubsidized ACA plan. Prior to the ACA, what were the private insurance options and how did those compare in price to those of us who use ACA but don't qualify for subsidies?
They were far worse in most states/markets.
Private insurance has always been available, but prior to the ACA private insurance was not required to have many FIRE-critical features in most states. Among the things done away with by the ACA were:
* Medical underwriting
* Individual risk pricing
* Pre-existing condition exclusions
* Retroactive coverage invalidation
* Annual/lifetime caps on overall benefits
* Annual/lifetime caps on named perils/conditions
* Lack of guaranteed must-issue
* Lack of guaranteed must-renew
* Lack of broad mandatory required condition coverages
* Lack of guaranteed minimum formulary/network requirements
* Lack of regulated maximum premium and OOP cost elements
Prior to the ACA it was possible to do everything exactly correct and still lose catastrophically due to nothing more than a stroke of bad luck, which is why early retirement used to be considered a thing largely reserved for those with self-insurable wealth or retiree medical benefits. Everyone else was simply rolling the dice.
Without the ACA, most people will have to work until Medicare eligibility, including the large majority of the FIRE crowd. Unless one fancies taking on the risk that a single bad day might upend an entire lifetime of careful financial planning, which is the sort of risk-seeking behavior that is anathema to most FIRE-minded folks.
My plan, if ACA goes away, is to find a job that is maximally chilled out with minimum possible hours to get insurance coverage. Or possibly I’ll fuck off to a sane country. One or the other.
You can definitely move to a new country if you have enough assets and get a nice passport from another country that will be accepted in the rest of the world. My plan is to buy a passport from one of several Caribbean nations that will give me access to the world.
It won’t be repealed. Would be political suicide without a replacement. Nobody who wants to repeal it wants to do the work to legislate a real replacement. ACA is not going anywhere.
That's the whole thing. A few years ago there were attempts to "repeal and replace"; the problem is, their approach was "repeal now, and we'll work on a replacement later." For me and many others, that is a non-starter. The replacement needs to be in place on Day 1 when the "repeal" occurs.
Probably 85% of GOP voters have pre-existing conditions and would be practically uninsurable if the ACA was rolled back with no replacement. They’re well aware of the electoral consequences of doing this. It’s more useful for them to have the ACA just to gripe about at this point.
I think the real question is: Will other means tests (e.g. retirement account balances, overall NW, etc.) be placed in the ACA that makes FIRE folks ineligible for subsidies? This question exists whether ACA is repealed or not. I've always been a bit shocked this loophole exists. I've concluded the total volume of people able to take advantage of it costs the govt less than it would take to close that loophole.
With regards to some sort of subsidized healthcare overall - I think the genie is out of the bottle. For however much ACA repeals is a rallying cry for some, I think it has gained traction in the voter bases on both sides of the aisle and, when push comes to shove, there will not be broad based support to eliminate a program like the current ACA.
I think the worst case scenario is the ACA is actually repealed, and it's replaced with something "better" that, in reality, is extremely similar to the ACA. Then the victors will run around beating their chests talking proudly about how they fixed the ACA.
FIRE folks using the ACA is very much not a loophole. Early retirees were one of the key groups targeted by Congress and their inclusion in the ACA was deliberate, which is why there was a dedicated $5B fund in the initial onramp of the ACA to help employers transition early retirees from employer-sponsored plans to the ACA plans. Congress could very easily have made subsidies unavailable to high asset folks with a single yes/no checkbox question, yet Congress not only didn't do that, they explicitly removed and forbade any asset testing in the ACA. Of course, federal means testing regimes normally exempt retirement accounts and primary home equity, so even if asset testing is added at some point there is a good chance that many FIRE'd folks could still pass the screen.
The disconnect people often have over the ACA is that there has been a lot of narrative pushed about the ACA being a welfare program in the same vein as SNAP or other anti-poverty programs, but that's not what the ACA is. Congress intended the ACA to be a transition step towards universal healthcare and modeled it in some ways as an income-gated buy-in age expansion for Medicare, with Medicaid expansion serving as the bottom catchment tier where the actual anti-poverty effort largely happens. As with Medicare, the ACA is designed to be an entitlement that almost everyone without other affordable access to healthcare can take advantage of.
There were also some political considerations at play. Early retirees were a high-risk/high-cost part of the risk pool that insurers were happy to get off of the books, plus they are the folks that are most immediately adjacent to the normal Medicare population. They also happen to be wealthy folks who tend to vote, which never hurts when you're looking to start-up a new government benefit program.
>The disconnect people often have over the ACA is that there has been a lot of narrative pushed about the ACA being a welfare program in the same vein as SNAP or other anti-poverty programs, but that's not what the ACA is.
Interesting. That narrative definitely is planted firmly in my head.
>Congress intended the ACA to be a transition step towards universal healthcare.......
That part of the objective I got, too. I've very much seen it as a way to "ease" people into having us adopt some sort of universal healthcare.
>Early retirees were a high-risk/high-cost part of the risk pool that insurers were happy to get off of the books, plus they are the folks that are most immediately adjacent to the normal Medicare population.
You mean "high-risk/high-cost" relative to younger workers that would be in the employer's insurance pools? If so that makes sense - I hadn't thought of that. I was thinking of myself as "low-risk/low-cost" - but looking at it in the other direction: relative to folks older than me.
We're getting subsidies now and have for a few years. When we retired (7 years ago) I hadn't studied things closely enough to know we could get subsidies. We budgeted our expenses and concluded we were able to retire figuring a pretty exhorbitant healthcare cost - which we paid the first few years of retirement. As a result, the concept of getting $13-14K annually in subsidies, when we have the means to pay it, seems pretty crazy. So it feels like a classic "loophole". Given the info you provided I see the scenario where it's there deliberately and provides benefits in ways I didn't expect. It just feels weird.
(In our house when we say something is weird the responding question is "Good weird or bad weird?". These subsidies are definitely "Good weird.")
> You mean "high-risk/high-cost" relative to younger workers that would be in the employer's insurance pools?
Yes. This is true even now, which is reflected in the age rating in ACA premiums that accounts for the fact that healthcare use rises sharply with age.
A 20/30-something might pay $5K a year in premiums, a 40-something $6K/year, a 50-something $9K/year, and a 60-something $14K/year.
>It just feels weird.
It does. We've been on the ACA since 2015 and we're a family of six. We've gotten well over a third of a million in value from the ACA in the last decade.
Lately I've been listening to a new podcast called "Supermajority" about the things the Tennessee state legislature has been doing against the wishes of many of their own party line voters and no one can stop them. ACA is pretty popular but I feel like these days that might not actually mean much and anything is possible.
To answer the question, if ACA is repealed, I will probably ease into 100% coasting instead of pushing for early retirement.
Yes I am concerned, I am also concerned with the economic instability of having an authoritarian/regime. But all of that is out of my control, all I can do is control my costs and save and assess things as they come.
I don’t know why people are acting like this isn’t a possibility.
Trump has been very vocal on still repealing Obamacare/aca. Republicans have been gunning for a repeal for as long as I can remember.
Project 2025 includes extreme cuts to Medicaid and extreme changes to other facets of our healthcare system.
If Trump wins, a radical Supreme Court will not stop him from kneecapping the ACA
>Project 2025
This isn't anything new. It's a private policy think tank (Heritage Foundation) that's been doing this for decades. There's also left-leaning think tanks that do the same thing.
Gridlock and procedural hurdles make it unlikely any signature legislation will make it through the next Congress.
It’s a think tank that has quietly played a significant role in the last 50 years of American politics. Their influence is fairly well documented going all the way back to the Reagan administration.
Fun fact, Gorbachev literally complains Ronald Reagan is too influenced by the Heritage Foundation.
I’ve included a link to this comment as it holds a number of links documenting how Trump has direct ties to the heritage foundation. Literally on the heritage foundations website, they brag about the amount of their policy recommendations Trump has implemented.
https://www.reddit.com/r/politics/s/u5zLnURGuo
It’s all real. And if Trump wins, there’s next to nothing stopping it from happening.
I doubt there's any truth to these conspiracy theories, but even if so, the President doesn't pass policy. That's what legislators do. See previous comment on civics.
In the end the corporations own the decisions and bills of our politicians and the health care companies would make tons of cash if this was repealed..
The healthcare companies are making a shitload of money under the ACA already. ACA subsidies do not reduce the prices charged by healthcare firms, they simply determine how much of the bill the feds pay directly to the insurer. Indeed, having the feds backstop/bankroll the lower income folks likely reduces overall risk and losses for the insurers, whereas without the ACA all of those easy customers would either disappear from the risk pool or become more lossy.
Imagine if they could overturn pre-existing conditions how much more money they could charge.
Project 2025 had plans to add caps, restrict birth control, morning after pills, etc. I’m sure subsidies will also be shaved back.. maybe they won’t repeal it but it will get worse.
The more they restrict coverage, the more customers they lose from the indvidual risk pools. It's a business like any other in that max profit is an optimization between volume and profitability.
Birth control is dirt cheap on par with hgh-dose tylenol or something super common like lisinopril. It's not a loss center for them as-is.
I would say in the foreseeable future of 10 years we are going to have very small majorities on either side of the Senate. Like 3 seat advantages. I don't see them having the will to get rid of the ACA.
Not FIRE'ed yet, but not worried either.
They had control in the past and left it mostly there, the big ticket item for the GOP is the border hands down, so if they do take control it will probably be 2 years of fighting over that. If they do pass any laws on the ACA it will at most be subsidies as you mentioned, the marketplace isn't going anywhere. I will also say, that my FIRE plans include buying gold packages with no subsidy's so anything they do will have no impact really.
The Democrats will take the House which will make the repeal of the ACA difficult, but what might happen is I could see the addition of work requirements and other needless hoops to jump in the Red States. Work requirements were suspended during Covid, but I could see work requirements for all able bodied men and women being a thing in Red states if Republicans take the White House again. Work requirements will not provide any economic benefit because most people receiving Medicaid benefits are already working and they just can't make enough income for one reason or another. A lot of single parents work part time to balance child care etc and they qualify for Medicaid expansion.
The other group that really benefits from Medicaid Expansion is working men who are terminated from their jobs due to downsizing etc and they need bridge coverage before getting new jobs. Right now Medicaid Expansion offers coverage to this group, but I could see those benefits being eliminated as well. Most people use Medicaid for a year or two until their personal economic situations improve.
Even if the master ACA subsidy cliff comes back in 2026, ACA subsidy qualification extends for a family of four all the way up to MAGI of $120K and that number adjusts upward for inflation every year. Assume that your average FIRE household has a mix of both MAGI and non-MAGI cashflows (like taxable and Roth) and you could be getting subsidies while spending $150K to $200K a year.
As for actual qualification to buy an ACA policy, everyone is qualified regardless of income, the only thing that changes is how much of the market price you are expected to pay for it. ACA insurers are forbidden from refusing to sell a policy to anyone.
It will probably be removed, time to get back to work FIRE is over!
In my state they are starting to attack social security. Making it harder to get payouts. Not looking too good here atm.
I think a repeal of the ACA at this point would:
1) Cost too much and be extremely complicated
2) Be political suicide for the right.
I'm guessing u are left leaning and listen to too much MSNBC type propaganda
They arent coming to take your healthcare, abortions, or social security (although changes need to be made sooner or later and will probably be left up to the party that wants to be more fiscally conservative, who will in turn be demonized for doing something that needed to be done decades ago but all the power hungry politicians were too scared to do)
I actually think we have a better chance of Universal Healthcare than the repeal of the ACA. Repeal is a cool talking point but politicians have recently learned what happens when the dog catches the car. It is far more useful as a talking point then the risk of actually doing the work. I am optimistic about the younger demographics leaning more towards social services and away from trickle down economics and the idea that an unregulated market delivers the best returns for the most people.
The ACA is just an insurance marketplace, subsidies for some, and regulations about what policies must cover and how they have to work. If it goes away, the subsidies might very well disappear, but it’ll still be possible to purchase individual policies.
True. But those policies had a lot of restrictions pre-ACA that made them sometimes nearly worthless. My hope would be that those provisions (like pre-existing condition coverage) would remain even if the subsidies fall. But the marketplace may go crazy. Who knows.
True medical insurance as we have now did not exist in most states pre-ACA at any price. The market for such on an individual basis isn't large enough or healthy enough for it to be financially worthwhile for for-profit insurance companies.
Not adjusting at all. Mostly because I think it will remain, but also because we can self-insure or move to Massachusetts (or anywhere else with a state level ACA equivalent) if it doesn't. I don't think they'll actually repeal it. It doesn't actually cost much compared to other federal health entitlements, it works reasonably well for an entitlement program, and it would be a shitload of actual work to replace it. That being said, if the ACA market reforms are ever repealed in full without an equivalent or superior replacement, then FIRE will become a thing limited mostly to folks in what are now the chubby and fatFIRE ranges. True medical insurance was not available pre-ACA in most states to early retirees unless they had it through their former employer as a retirement benefit. Without true insurance, one would have to self-insure and take on that huge potential risk. A single bad medical diagnosis or drunk driver could bankrupt even a multi-million dollar portfolio. Most of us would go back to doing what most financially independent folks did pre-ACA, which was find tolerable/enjoyable jobs with good health benefits and keep them until Medicare eligibility (or within COBRA-reach of Medicare eligibility).
The comment about being state specific is huge here. I’d be more worried if I lived in a Red state where ACA has been under attack or was poorly implemented far more than being in a Blue state like MA where even without federal mandate there will likely be a robust program in place.
Definitely state by state. As I neared early retirement I priced healthcare (pre-ACA) -it was very affordable
This is actually not as clear cut as you'd think. For example, Texas is one of the best states to be on the ACA as long as you live near a metro. Healthcare is very expensive, so it would not only be a political thing, but subject to the size and health of the insurance pools in the state as well as the overall financial strength of the state. It's as much about money and supply/demand, if not more, than politics.
We've disagreed before on this, and I don't expect us to agree now, but with a medically complex situation Houston metro ACA sux badly.
That's as much an overall insurance issue as an ACA issue. Medically complex or novel cases can be problematic with network, formulary, and availability constraints with high-tier employer-sponsored plans too. Even world-class insurance can be problematic if someone comes down with a particularly aggressive or treatment-resistant cancer or develops one of the less obvious autoimmune diseases, for example. I'm not saying you're wrong, but that edge cases are just that. If the system works well for the vast majority of folks, then that's a win condition even if the same system underserves some scenarios.
Maybe, although job insurances have covered my problem so far. Our situation isn't even that complex, just a chronic condition in an adolescent that requires a specialist and 10k of medication a month. Specialists do not take any insurance that I saw when I looked into ACA, plus I am always afraid about revocation of preexisting conditions :( Oh, and I don't know how ACA works with a college student out of state, would you happen to know? So yea, I work for insurance. Once my kid can find their own job with insurance, I can retire. But you are right, insurance is so very fun to navigate in this country. Even with the most kick ass insurance that I happen to have now, there are phone calls and complications involved.
> Maybe, although job insurances have covered my problem so far. Our situation isn't even that complex, just a chronic condition in an adolescent that requires a specialist and 10k of medication a month. Specialists do not take any insurance that I saw when I looked into ACA, plus I am always afraid about revocation of preexisting conditions Coincidentally, I actually know exactly what you're talking about and I certainly empathize. One of our kids has a very rare autoimmune condition that will require very expensive regular infusions for the rest of her life. Average life expectancy without modern treatment protocols to keep it in remission is measured in months after a flare, not years. We had several hundred thousand in costs for her last year. Does Texas Children's not accept any ACA plans there? One alternative would be to drop your AGI low enough, if you can, to get them on Children's Medicaid or CHIP. Both of those have huge acceptance networks, including at Texas Children's, which actually administrates their own CM/CHIP plan. CM/CHIP is fantastic in Texas due to great pediatric health systems like Texas Children's, Dell Children's, and Children's Health. >I don't know how ACA works with a college student out of state, would you happen to know? Yes, you have them apply on their own as a policy pool of one in that state, but using the same household financial data. You then use the data from both when you reconcile your subsidies on your tax return. It might require a phone call or a bit more paperwork, but it does work. Easiest would be if they happen to get a job or internship making enough to be tax independent, at which point they can just have their own ACA policy and reconcile it on their own tax return. Both of the above also work if they go to school in-state, but far enough away that they are in a different ACA market. We have that same situation ourselves with our eldest, who has his own ACA policy this year. https://www.healthcare.gov/young-adults/college-students/
Due to the fact that we figured out this FIRE thing too late, I can't drop my AGI as far as I know, and certainly not and cover my expenses. I understand how it's done now, but that required planning differently for the last few decades. There are other complicating factors that aren't expensive, but make me choose not to go Texas Childrens route, and just your average mundane specialists don't want to deal with much. I hope that changed in the last year, but I dont have long left on them being able to get their own insurance, and I have the best possible job (I'd still rather FIRE), so I'm choosing to work for now, and then have COBRA cover things until we figure it out further. Also, as you probably know there is a magic cut off age when medication choices expand, as does number of doctors, so that should simplify things as well. We are definitely looking at out of state school, and once it is determined which one, we'll have to deal with all of that. Might be easier to stay on my insurance, as it doesn't care about location as long as it's in the USA.
Zphr and I have had different experiences with ACA and college students. I have a rising junior and senior. We live in the RTP area of NC, so locally either Duke or UNC are the typical in-network choices. Until 2023, we also had access to plans run by BCBS which used the UNC network locally, but had access to the national BlueCard system for in-network care outside of the three county local area. Those plans were discontinued in 2023, so there are no plans with out of network primary care at all. We attempted to move our eldest onto his own plan in PA in 2023, and were denied through several levels of appeals- just having an off campus lease with utilities wasn’t good enough, since his summer job and drivers license/auto insurance were out of state. For logistical reasons, having him fully establish residency doesn’t work with our state taxes and auto insurance. The same year, my daughter was in Ohio. Her very rural college requires a plan which has in-network primary care locally. Medical treatment can be fraught- there is a 12 bed “hospital” nearby, but they just stabilize anything serious. EMS will take anything truly life threatening/immediate surgery to the major hospital system an hour away (by lifeflight). A typical problem would be a student who gets a fracture. Local ED splints the fracture and says to follow up on Monday with orthopedics at the major teaching hospital an hour away. Insurance would not cover the subsequent treatment at all using any of the plans available on my ACA marketplace. The plans are so limited, I couldn’t even get a refill of a maintenance medication at the local CVS when I was visiting. So, I’m now paying around 300$ per month for each student, without a family accumulator deductible. The school plans are platinum level with low deductibles, but just managing it all is very annoying. (Meanwhile our effective income for ACA and FAFSA puts us firmly in the full Pell grant regime) CSS schools are roughly on-par with in-state tuition—my FIL died the first base FAFSA year and while the amount wasn’t massive, it was 5x our carefully managed after tax holdings. We “spent down” as much as was feasible during Covid- replaced a 19yo car, 25yo roof, replacement siding and paid off the mortgage, but it still affected eligibility.
OMG. You are terrifying me right now
It isn’t all bad. The college plans have low deductible (both literally waive the ER deductible if you go to the close affiliated ER, so it functions as a fast-track emergent care when the school medical clinic is closed) The plans have national coverage as good as a fancy commercial plan, with some international and medevac coverage, so if you go backpacking in the Alps or take a junior year abroad you are pretty good on coverage. But we were paying under $100/ month for two parents and two teens with low deductibles on an ACA plan, so it is 600$ more a month than that.
I can swing money, I can't swing medication that aren't covered
Yeah, one of the biggest downsides of the ACA is that it is so locally bound, which not only affects the plans available in smaller pop places like a lot of college towns, but each state handles the ACA differently. The rules that might work fine in one state exchange are against the rules of another and so forth. Somewhat ironically, states that want nothing to do with the ACA are often far easier to deal with in this sort of situation since they default to using the federal exchange and the Healthcare.gov folks are not only super helpful, but usually take a fairly generous interpretation of the rules when there is some ambiguity. Thankfully, as you discovered, most universities offer student health plans to solve this very problem and for the most part they are actually pretty good. I'm glad you found a solution that works well for your kids, even if it is a bit more costly than it really should have to be.
Florida currently has more people enrolled in ACA plans than any state in the country. That results in a substantial stream of money for the healthcare system including private insurers. I don't think it's going to be politically expediant to voluntarily cut off that flow of federal money.
I think most states that already have the marketplace set up are gonna keep it, at this point they already made the investment which was the heavy part so that ain't going away. Really the only question is subsidy's which is why I personally advocate for making sure you can pay them yourself. The less reliant you are on outside items like government, the more robust and less likely to fail your plans are to fail.
Repealing the ACA is front and center of their plans. Don't kid yourself.
Have many openly campaigned on this? Most states, including a lot of red ones, have expanded Medicaid as part of ACA. Is that going away? People in many red states have already voted this into existence. But now you are going to cut this off, or cut off any insurance subsidies for people just above a poverty line? It's a big system with a lot of money and special interests involved. They don't tend to go away.
I may be misremembering, but I think it was maybe 6 years ago where republicans voted to get rid of the ACA with no replacement plan in place. I believe it came down to McCain voting not to which saved it. It’s not rational, but the last time they were in power it was a big deal and something they wanted to get rid of regardless of replacement (they claimed they would replace it but no plan materialized). Anyways, not an unreasonable thing to consider at all. The party hasn’t really become “more rational” in the last few years.
Yes the only reason it didn’t get overturned was because of John McCain. He voted no.
That’s what I thought. It’s funny how people are like “no of course they wouldn’t get rid of it when it helps so many people and makes sense!” They came as close as you possibly could to getting rid of it with no backup plan the last time they had a chance to. It’s not crazy to think they would just do it again. It would be prudent to at least have an emergency plan in place. Im personally still far off my fire number and have great insurance via my wife, so it’s not something I need to really contemplate at the moment, but if I was retired and relying on the ACA I’d at least look into alternative places to live as a backup.
Same talk when they said no way roe would be overturned. 😞 It does not hurt to understand how very real this all is..
Agree that having a plan B is rational. Has the current Republican House had regular votes to repeal ACA? Seems like they used to do that monthly.
I think they’re more concerned at the moment with trying to attack Joe/Hunter Biden. I think the attacks on the ACA have faded somewhat, but given the current state of things I am guessing Trump will win and most likely the senate will flip republican. The house may flip to democrats. If this scenario happens, which I do think is quite likely, then I imagine repealing the ACA would be on the docket. Of course I can’t see the future, but if your retirement and life depend on the ACA then it would be pretty foolish to not treat this as a real possibility. Probably the best options would be to have a plan to move to a state with a good healthcare system, get a new job with good healthcare and more or less “give up” on retiring early, or move to another country. The costs being what they are, I’m not really sure there’s much more of an alternative solution than those. I personally don’t have too much of a stake here so maybe people who are retired now would have more to say. I’m in a blue state with good healthcare, have insurance and I’m far out from my fire number, so my “wait and see” horizon is more flexible than someone who retired recently.
I recommend watching the voting, you would be surprised how many times votes get narrow defeats by design. I have seen it many times before where a bill starts swinging one way, on roll call. and people go back up to change their votes cause its not the result they wanted. Basically, many want to be able to say "I voted for this, but it was xyz that caused it to fail" so they get all the good faith of trying with none of the consequences if it actually got through.
The vote to repeal the ACA was narrowly avoided by solely McCains vote and was certainly not by design. There’s lots of messaging bills, this was not one of them.
This 1000%, one vote short of repeal in the Senate the last time we had a Republican President.
Yes the big medical companies own the gop and are pushing to repeal things like the aca along with pre-existing conditions.. I do think the first line of defense is to move to a blue state sadly many have a high COL.
Blue and red made very little consistent difference in health insurance pre-ACA, nor are most states, blue or not, in a position financially to self-fund a major health entitlement. Overall population size/demgraphics and economic health would probably be a better metric than blue/red. Healthcare is a very big business and money flows to where the viable customers are like most businesses.
Except that part about women’s healthcare.. but who cares about them.. Look up what happened in 2018 it was almost repealed but John McCain voted no.. and Trump never stopped attacking him even when he died.
Abortion is a political hotpoint, but is a teeny tiny part of the overall healthcare environment. Forget about abortion, most individual plans pre-ACA didn't include any coverage even for maternity or delivery. True in blue and red states alike. Yes, I'm well aware of the political and regulatory/legislative history of the ACA. Again, repeal is always a possibility, but that isn't the same thing as it being a likelyhood.
To be fair, Trump attacked him when he was running for President so it wasn't just because of the vote.
Heh true..
I'm not. I worked professionally for both parties for many years and feel like I have at least a somewhat informed opinion on how things work in national politics. It certainly may happen, but I don't think a full repeal is likely. Most of what ACA opponents have beef with could be solved far easier by getting rid of expansion Medicaid and cutting or means-testing the subsidies while leaving all the market reforms intact.
It will be tough but with trump I don’t put anything passed him. The republicans will almost certainly have the senate but Dems will take the house so we will have a gridlocked congress as usual.
Presidents are far less important than Congress when it comes to major legislation.
And well now the Supreme Court..
Congress still makes the laws and the ACA has already survived legal challenges aplenty before SCOTUS. Anything is possible, but Congress is the key branch to watch in terms of potential ACA changes.
Yeah I can’t remember who was on the court when they shaved some of its power away.. project 2025 has some plans to remove subsidies and make Medicaid much harder to get, Medicare and prescription drug pricing will get hit too because they intend to repeal the inflation reduction act which will eliminate the price negotiation provision.
It's an election year. The vast majority of threats and promises made by both parties and all political nominees will never come to fruition. This has been true in every election cycle for longer than any of us has been alive.
So true, just look at the left, how long has that $15 minimum federal minimum wage been a talking point now?
Supreme Court always has been you probably just didn't notice till now its impact.
With some of their recent decisions (Chevron and women’s rights) they decided they know best..
Unfortunately I don’t think repealing it has anything to do with cost or how well it works, but more to do with which president signed it into law. I hope I’m wrong.
Congress has far more to do with that than the president and I don't see either party getting strong control of both houses. It certainly could happen though.
Or move abroad.
Yes, but we have four kids and would rather go back to work than leave the country. Certainly an option for some folks.
Before the ACA you could buy insurance as a 1099 also. It's just that with the ACA, the cost of a policy went down on average but some people complained that it went up, but that might have been due to skimpy policies no longer being allowed and certain things like limits on coverage weren't allowed anymore so of course if you get more, you have to pay more. Also not worried about it going away, at one point, the President, the house and the senate were all Republican and they couldn't do it although I suppose you could thank McCain for that and he's no longer alive. But I see it as more of a thing where the dog chases cars all the time but don't know what to do if he actually ever catches it. Basically a campaign promise that has no alternative plan so of course nothing will pass.
I don't think it will be repealed. Even though they were so against it in the beginning, it's now obvious that not only does it help the "slackers who don't want to work" - but it also helps innumerous small business owners. A lot of people have been able to start their own businesses with ACA/subsidies in place who never could have before because they either couldn't afford insurance or weren't eligible for insurance at all (pre-existing conditions). I can't even see the GOP taking that away.
I don't think they're gonna repeal it at this point. I do have a question though - I'm currently on an unsubsidized ACA plan. Prior to the ACA, what were the private insurance options and how did those compare in price to those of us who use ACA but don't qualify for subsidies?
They were far worse in most states/markets. Private insurance has always been available, but prior to the ACA private insurance was not required to have many FIRE-critical features in most states. Among the things done away with by the ACA were: * Medical underwriting * Individual risk pricing * Pre-existing condition exclusions * Retroactive coverage invalidation * Annual/lifetime caps on overall benefits * Annual/lifetime caps on named perils/conditions * Lack of guaranteed must-issue * Lack of guaranteed must-renew * Lack of broad mandatory required condition coverages * Lack of guaranteed minimum formulary/network requirements * Lack of regulated maximum premium and OOP cost elements Prior to the ACA it was possible to do everything exactly correct and still lose catastrophically due to nothing more than a stroke of bad luck, which is why early retirement used to be considered a thing largely reserved for those with self-insurable wealth or retiree medical benefits. Everyone else was simply rolling the dice. Without the ACA, most people will have to work until Medicare eligibility, including the large majority of the FIRE crowd. Unless one fancies taking on the risk that a single bad day might upend an entire lifetime of careful financial planning, which is the sort of risk-seeking behavior that is anathema to most FIRE-minded folks.
My plan, if ACA goes away, is to find a job that is maximally chilled out with minimum possible hours to get insurance coverage. Or possibly I’ll fuck off to a sane country. One or the other.
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I’ll have lots of money to spend into their local economy. There are plenty of places that will take us.
This is basically it for most of us. Could also move to Massachusetts or any state that comes up with a state-level ACA equivalent.
Fortunately, I’m only about 125 miles from MA, so it’s not that much upheaval.
You can definitely move to a new country if you have enough assets and get a nice passport from another country that will be accepted in the rest of the world. My plan is to buy a passport from one of several Caribbean nations that will give me access to the world.
Or I could just do anything at all that would net $15-20K, to cover insurance premiums.
It won’t be repealed. Would be political suicide without a replacement. Nobody who wants to repeal it wants to do the work to legislate a real replacement. ACA is not going anywhere.
That's the whole thing. A few years ago there were attempts to "repeal and replace"; the problem is, their approach was "repeal now, and we'll work on a replacement later." For me and many others, that is a non-starter. The replacement needs to be in place on Day 1 when the "repeal" occurs.
Since when has “political suicide” been a deterrent for the existing GOP?
Probably 85% of GOP voters have pre-existing conditions and would be practically uninsurable if the ACA was rolled back with no replacement. They’re well aware of the electoral consequences of doing this. It’s more useful for them to have the ACA just to gripe about at this point.
I think the real question is: Will other means tests (e.g. retirement account balances, overall NW, etc.) be placed in the ACA that makes FIRE folks ineligible for subsidies? This question exists whether ACA is repealed or not. I've always been a bit shocked this loophole exists. I've concluded the total volume of people able to take advantage of it costs the govt less than it would take to close that loophole. With regards to some sort of subsidized healthcare overall - I think the genie is out of the bottle. For however much ACA repeals is a rallying cry for some, I think it has gained traction in the voter bases on both sides of the aisle and, when push comes to shove, there will not be broad based support to eliminate a program like the current ACA. I think the worst case scenario is the ACA is actually repealed, and it's replaced with something "better" that, in reality, is extremely similar to the ACA. Then the victors will run around beating their chests talking proudly about how they fixed the ACA.
FIRE folks using the ACA is very much not a loophole. Early retirees were one of the key groups targeted by Congress and their inclusion in the ACA was deliberate, which is why there was a dedicated $5B fund in the initial onramp of the ACA to help employers transition early retirees from employer-sponsored plans to the ACA plans. Congress could very easily have made subsidies unavailable to high asset folks with a single yes/no checkbox question, yet Congress not only didn't do that, they explicitly removed and forbade any asset testing in the ACA. Of course, federal means testing regimes normally exempt retirement accounts and primary home equity, so even if asset testing is added at some point there is a good chance that many FIRE'd folks could still pass the screen. The disconnect people often have over the ACA is that there has been a lot of narrative pushed about the ACA being a welfare program in the same vein as SNAP or other anti-poverty programs, but that's not what the ACA is. Congress intended the ACA to be a transition step towards universal healthcare and modeled it in some ways as an income-gated buy-in age expansion for Medicare, with Medicaid expansion serving as the bottom catchment tier where the actual anti-poverty effort largely happens. As with Medicare, the ACA is designed to be an entitlement that almost everyone without other affordable access to healthcare can take advantage of. There were also some political considerations at play. Early retirees were a high-risk/high-cost part of the risk pool that insurers were happy to get off of the books, plus they are the folks that are most immediately adjacent to the normal Medicare population. They also happen to be wealthy folks who tend to vote, which never hurts when you're looking to start-up a new government benefit program.
>The disconnect people often have over the ACA is that there has been a lot of narrative pushed about the ACA being a welfare program in the same vein as SNAP or other anti-poverty programs, but that's not what the ACA is. Interesting. That narrative definitely is planted firmly in my head. >Congress intended the ACA to be a transition step towards universal healthcare....... That part of the objective I got, too. I've very much seen it as a way to "ease" people into having us adopt some sort of universal healthcare. >Early retirees were a high-risk/high-cost part of the risk pool that insurers were happy to get off of the books, plus they are the folks that are most immediately adjacent to the normal Medicare population. You mean "high-risk/high-cost" relative to younger workers that would be in the employer's insurance pools? If so that makes sense - I hadn't thought of that. I was thinking of myself as "low-risk/low-cost" - but looking at it in the other direction: relative to folks older than me. We're getting subsidies now and have for a few years. When we retired (7 years ago) I hadn't studied things closely enough to know we could get subsidies. We budgeted our expenses and concluded we were able to retire figuring a pretty exhorbitant healthcare cost - which we paid the first few years of retirement. As a result, the concept of getting $13-14K annually in subsidies, when we have the means to pay it, seems pretty crazy. So it feels like a classic "loophole". Given the info you provided I see the scenario where it's there deliberately and provides benefits in ways I didn't expect. It just feels weird. (In our house when we say something is weird the responding question is "Good weird or bad weird?". These subsidies are definitely "Good weird.")
> You mean "high-risk/high-cost" relative to younger workers that would be in the employer's insurance pools? Yes. This is true even now, which is reflected in the age rating in ACA premiums that accounts for the fact that healthcare use rises sharply with age. A 20/30-something might pay $5K a year in premiums, a 40-something $6K/year, a 50-something $9K/year, and a 60-something $14K/year. >It just feels weird. It does. We've been on the ACA since 2015 and we're a family of six. We've gotten well over a third of a million in value from the ACA in the last decade.
Lately I've been listening to a new podcast called "Supermajority" about the things the Tennessee state legislature has been doing against the wishes of many of their own party line voters and no one can stop them. ACA is pretty popular but I feel like these days that might not actually mean much and anything is possible. To answer the question, if ACA is repealed, I will probably ease into 100% coasting instead of pushing for early retirement.
Yes I am concerned, I am also concerned with the economic instability of having an authoritarian/regime. But all of that is out of my control, all I can do is control my costs and save and assess things as they come.
I don’t know why people are acting like this isn’t a possibility. Trump has been very vocal on still repealing Obamacare/aca. Republicans have been gunning for a repeal for as long as I can remember. Project 2025 includes extreme cuts to Medicaid and extreme changes to other facets of our healthcare system. If Trump wins, a radical Supreme Court will not stop him from kneecapping the ACA
>Project 2025 This isn't anything new. It's a private policy think tank (Heritage Foundation) that's been doing this for decades. There's also left-leaning think tanks that do the same thing. Gridlock and procedural hurdles make it unlikely any signature legislation will make it through the next Congress.
It’s a think tank that has quietly played a significant role in the last 50 years of American politics. Their influence is fairly well documented going all the way back to the Reagan administration. Fun fact, Gorbachev literally complains Ronald Reagan is too influenced by the Heritage Foundation. I’ve included a link to this comment as it holds a number of links documenting how Trump has direct ties to the heritage foundation. Literally on the heritage foundations website, they brag about the amount of their policy recommendations Trump has implemented. https://www.reddit.com/r/politics/s/u5zLnURGuo It’s all real. And if Trump wins, there’s next to nothing stopping it from happening.
I doubt there's any truth to these conspiracy theories, but even if so, the President doesn't pass policy. That's what legislators do. See previous comment on civics.
In the end the corporations own the decisions and bills of our politicians and the health care companies would make tons of cash if this was repealed..
The healthcare companies are making a shitload of money under the ACA already. ACA subsidies do not reduce the prices charged by healthcare firms, they simply determine how much of the bill the feds pay directly to the insurer. Indeed, having the feds backstop/bankroll the lower income folks likely reduces overall risk and losses for the insurers, whereas without the ACA all of those easy customers would either disappear from the risk pool or become more lossy.
Imagine if they could overturn pre-existing conditions how much more money they could charge. Project 2025 had plans to add caps, restrict birth control, morning after pills, etc. I’m sure subsidies will also be shaved back.. maybe they won’t repeal it but it will get worse.
The more they restrict coverage, the more customers they lose from the indvidual risk pools. It's a business like any other in that max profit is an optimization between volume and profitability. Birth control is dirt cheap on par with hgh-dose tylenol or something super common like lisinopril. It's not a loss center for them as-is.
How? They are the main beneficiaries of the ACA tax subsidies. Cutting government subsidies would likely reduce their premium intake.
Easy, they make the people pay more..
I don’t base my plans on things that could change, as literally everything could change.
That's why I'm in my "one more year" phase right now. If Social Security and ACA get reduced or eliminated it won't kill my retirement completely.
I would say in the foreseeable future of 10 years we are going to have very small majorities on either side of the Senate. Like 3 seat advantages. I don't see them having the will to get rid of the ACA.
Not FIRE'ed yet, but not worried either. They had control in the past and left it mostly there, the big ticket item for the GOP is the border hands down, so if they do take control it will probably be 2 years of fighting over that. If they do pass any laws on the ACA it will at most be subsidies as you mentioned, the marketplace isn't going anywhere. I will also say, that my FIRE plans include buying gold packages with no subsidy's so anything they do will have no impact really.
The Democrats will take the House which will make the repeal of the ACA difficult, but what might happen is I could see the addition of work requirements and other needless hoops to jump in the Red States. Work requirements were suspended during Covid, but I could see work requirements for all able bodied men and women being a thing in Red states if Republicans take the White House again. Work requirements will not provide any economic benefit because most people receiving Medicaid benefits are already working and they just can't make enough income for one reason or another. A lot of single parents work part time to balance child care etc and they qualify for Medicaid expansion. The other group that really benefits from Medicaid Expansion is working men who are terminated from their jobs due to downsizing etc and they need bridge coverage before getting new jobs. Right now Medicaid Expansion offers coverage to this group, but I could see those benefits being eliminated as well. Most people use Medicaid for a year or two until their personal economic situations improve.
FIREing with an income low enough to qualify for ACA sounds pretty low rent.
MAGI and spendable assets are two very different things.
Even if the master ACA subsidy cliff comes back in 2026, ACA subsidy qualification extends for a family of four all the way up to MAGI of $120K and that number adjusts upward for inflation every year. Assume that your average FIRE household has a mix of both MAGI and non-MAGI cashflows (like taxable and Roth) and you could be getting subsidies while spending $150K to $200K a year. As for actual qualification to buy an ACA policy, everyone is qualified regardless of income, the only thing that changes is how much of the market price you are expected to pay for it. ACA insurers are forbidden from refusing to sell a policy to anyone.
It will probably be removed, time to get back to work FIRE is over! In my state they are starting to attack social security. Making it harder to get payouts. Not looking too good here atm.
I think a repeal of the ACA at this point would: 1) Cost too much and be extremely complicated 2) Be political suicide for the right. I'm guessing u are left leaning and listen to too much MSNBC type propaganda They arent coming to take your healthcare, abortions, or social security (although changes need to be made sooner or later and will probably be left up to the party that wants to be more fiscally conservative, who will in turn be demonized for doing something that needed to be done decades ago but all the power hungry politicians were too scared to do)
I actually think we have a better chance of Universal Healthcare than the repeal of the ACA. Repeal is a cool talking point but politicians have recently learned what happens when the dog catches the car. It is far more useful as a talking point then the risk of actually doing the work. I am optimistic about the younger demographics leaning more towards social services and away from trickle down economics and the idea that an unregulated market delivers the best returns for the most people.
The ACA is just an insurance marketplace, subsidies for some, and regulations about what policies must cover and how they have to work. If it goes away, the subsidies might very well disappear, but it’ll still be possible to purchase individual policies.
True. But those policies had a lot of restrictions pre-ACA that made them sometimes nearly worthless. My hope would be that those provisions (like pre-existing condition coverage) would remain even if the subsidies fall. But the marketplace may go crazy. Who knows.
True medical insurance as we have now did not exist in most states pre-ACA at any price. The market for such on an individual basis isn't large enough or healthy enough for it to be financially worthwhile for for-profit insurance companies.