Obamacare Commentary

Obamacare needs no introduction and the media has done a poor job of reporting the facts and providing meaningful information for viewers and readers to utilize.

Now that the political arguments have cooled somewhat, I believe it is important that everyone understand the impact of the law.  This law will impact everyone and stands to alter the state of our way of life at least enough that everyone should be interested in understanding it. The following information and text is heavily borrowed from Beating Obamacare Your Handbook for Surviving the New Health Care Law by Betsy McCaughey, Ph.D.  Dr. McCaughey is a Constitutional Scholar and patient advocate and former Lt. Governor of New York.  Dr. McCaughey has read and analyzed the entire 2000+ documents that set forth the new health care law. She has provided readers with this book to break the law down into digestible bits so that most anyone can understand the many different aspects of this law.  I sense much emotion in Dr. McCaughey’s writing though I do not doubt her integrity in the least.

I am providing my readers, with an even more compact overview of the law using this source and others that I am studying in a series of mini-blogs. In the areas of the Dr. McCaughey’s book that I am still trying to understand better, I have not commented.  I only provide information from the beginning of the book in this post, and I will publish more as I read and clarify my own understanding of other areas of my sources and the law.

Proponents of Obamacare are welcome to comment.  I intend nothing other than providing information. I respectively request that comments are fact-based supported by law, expertise, and not news reports.

This program requires taxpayers to foot the bill.  Despite the many arguments over socialized programs and whether or not Obamacare falls under that title, the new health care law does unquestionably overstep many Constitutional grounds. It is also without question that by necessity, changes and adjustments will need to be made in this law and its offshoot regulations and policies to follow.  It is important we speak to our elected officials. We need to make it known how we that are affected by this law will need to influence changes and adjustments.  As with any major change in our society, even Medicare upon its birth, scathing criticism, anger and fear of the unknown can all hamper our ability to see things for what they truly are and effectively participate in making the best of change. There are immediate benefits to this program. There too is immediate harm. It will be up to the American people to mandate that balance as time goes on. These are points in the book mostly from the actual text with a few of my comments.

Many Americans will lose their coverage provided by their employers in 2014.

Employers with more than 50 full-time workers are required to provide the government-designed health plan or pay a fine. Coverage is already expensive.  The government-designed health plans are also very expensive and are expected to cost more than the already high cost plans provided, now.

The Employer mandate adds $1.79 per hour to the cost of hiring a full-time worker.

This can be a real burden on companies with many low wage workers. Currently employers in retail and fast-food industries pay less than half the $1.79 per hour to insure their workers.  Some employers will opt for the fine in lieu of paying for more expensive health coverage while others expect to make full-time workers into part-time workers. So individuals will have to obtain private insurance plans that we are all required to have in 2014 in hopes that the plans offered through the exchanges will be affordable or that State Medicaid programs will be available to individuals that are not disabled, over 65, or have children, and low income.

As of 2014 you will have to show the IRS proof of Insurance when you file your taxes.

Or your refund can be withheld.

Under Obamacare, for the first time in history, the federal government will dictate how doctors treat privately insured patients.

§1311 of the law gives power to the Secretary of Health and Human Services to standardize what doctors do. There is not a lot of data in the book to expound on this statement, however, the fact remains that the government will have more power to intervene on how care is administered that it has before. This is also regardless of whether or not your pay for private insurance or receive Medicai

Seniors and baby boomers can expect less care than in the past.

Cuts to Medicare Funding (a program that the recipient has paid into all his life) will pay for more than half of the new law. This means approximately $247 billion less to care for the same number of seniors than if the law had not passed. Nurses in California have already begun striking over the increased workloads. When Medicare cuts caused reductions in nursing staff in the past, elderly patients had a lower chance of surviving their stay and death rates from heart attacks rose

If you sell your home and make a profit, you could be paying a new 3.8% tax on the gain.

The new law includes roughly a half a million dollars in tax increases.  A new tax on selling any asset; home, small business, stocks, or bonds, effective January 1, 2013. This is in addition to capital gains taxes and it applies to any gain that pushes your income over $200,000. Homeowners selling their primary residence could be exempt from the tax.  Point being it is very important to do your homework before selling off asset, going forward.

Low Income childless adults may become eligible for Medicaid if your state chooses to expand Medicaid.

Of course, there is still controversy over how this will be paid for and some states still have not decided on whether or not to expand the program to low income childless adults.

Households earning up to $92,200 for a family of four who pay for their own insurance will receive a subsidy funded by taxpayers.

Young Adults who are on their parent’s insurance can remain so to age twenty-six

I would like to make an extra comment regarding Medicare. There is nothing good about taking Medicare funds to pay for another program. There is also nothing good about changing the Medicare system into voucher system that would make seniors and disabled people fair game for misleading and predatory insurance sales companies. Some seniors and disabled have payee representatives that handle all or most of the financial aspect of the benefits received.  However, not all disabled people and seniors want to give up that independence and the current system is confusing enough. With that said, it is also important that we think of our seniors, disabled neighbors, and our own vulnerabilities as we age or get sick.

Dr. McCaughey’s book is very easy to read and touches a little broader on many of the above topics. http://www.amazon.com/Beating-Obamacare-Your-Handbook-Healthcare/dp/1621570797

 

Can my child recieve SSI even if I work?

In many instances the answer to this question is yes.  SSI is a disability program through Social Security that provides supplemental income to those 65 and older or disabled or blind with limited resources. Children can qualify for SSI if they meet the medical requirements set forth by the SSA and if the household the child resides meets the income and asset requirements.  Even for children with working parents, they may still qualify for SSI.

The amount if any a child can receive will be determined depending on how many children reside in the home, income earned or unearned collected by the parents or guardians, and other resources .  To illustrate, Ohio sets forth the following rules (generalized as there are sometimes a rare exception):

• The parents or guardians may only have one vehicle, each
• The parents or guardians may only own one home in which they must reside
• There can be no more than $2500 in total assets beyond the home and cars.
• Depending on the number of children, there are income maximums for both earned and unearned income.  Depending on these numbers the child can received a portion up to the maximum amount of SSI allowed. The amount will decrease according to the income the household receives and can increase depending on the eligible household members.  See the SSA webpage for more information.
• The amount of earned income allowed is higher than the amount of unearned income allowed in most cases.

The amount of SSI paid to the child of working parents may be somewhat less than the maximum benefit. Yet some extra funds can prove to be tremendously helpful for a family struggling with expenses to care for a special needs child. Also, depending also on income and resources, the child may also qualify for Medicaid once he is found to be disabled.

When applying for SSI for a child, the application process will begin with an assessment to be certain the family is not over resource to qualify. Once the financial application is complete and accepted, then the medical decision will be made by the state department of disability as to whether the child is medically disabled under the SSA’s guidelines.

April L Roberts, ADR is an Accredited Disability Representative and operates a solo practice in Berea, OH Aaria Consulting^®, LLC. All Content is property of the author.

ABC’s of Social Security Disability for the Claimant

For many people, “Disability Benefits” is a blurry term meaning income for a person that has become disabled and is no longer able to work. There are varying perceptions that people have regarding Disability Benefits and what Social Security programs entail.  Along with many misconceptions, a lot of people do not know they are eligible and others mistake one program for another to their frustration. Currently, the Social Security Administration, (SSA) offers claimants more information about its Disability and Retirement programs via its website. However, not everyone is computer savvy and not all questions can be answered, easily. There is no way to address all aspects of the disability programs and eligibility in this medium.  However, I will provide some basics that may be helpful in understanding Disability Benefits. Note that some of this information is general and depending on where you live and specifics to your claim your experience may be different than described, below.

What is Social Security Disability?

Here I address the two main Disability programs through Social Security; SSDI and SSI.  I will begin with the original Disability Benefits program, SSDI, also known as “DIB” and “Title II”. SSDI is a Social Security benefits program that pays income to a worker with a condition that has or will prevent him from working for a period of 12 months or more, or end in death.  When we work and pay taxes, we normally pay into the Social Security system that covers SSDI benefits. Generally, a person has to have earned enough “work quarters” (more to come on work quarters at a later date) to earn benefits coverage. This means there is a minimum amount of time you have to work and a minimum amount of earnings you have to accrue in order to be eligible for SSDI.  SSDI = Social Security Disability Insurance. The program is just that, insurance that you pay into. The amount you receive in benefits depends on your work quarters and earnings. Most of us get a statement from SSA to tell us our current retirement and disability benefit amounts. For younger individuals that have worked but have not earned the work credits required for SSDI, the rules are relaxed, some. For instance if you are only 21 years old and become disabled you have not met the standard work credit requirement. Yet, you still may be eligible for SSDI of you have worked.  Because SSDI is a program you earn eligibility for, your assets will not affect your eligibility.

SSI  or Supplemental Security Income, is the other Disability program through Social Security. SSI is a welfare program that pays income to an individual 65 or older, under 65 and disabled or blind, not eligible for SSDI and has limited financial resources. The program is also known as Title VXI and the amount of SSI you receive depends on your need and is capped. SSI is funded by both Federal and State money. Each state has different guidelines and asset minimums so it is important you check in your region for the qualifying rules. Children may receive SSI if they have a qualifying condition and live in a household that meets the income and asset guidelines. A family does not have to be completely destitute in order to collect SSI for a disabled child. It is possible for one or both parents or guardian can be working and the household still be eligible to receive SSI for the disabled child. The household simply needs to qualify under the requirements in that particular state.

This post does not address, however a spouse or child may qualify for benefits under someone else’s SSDI earnings. Your local Social Security office or Disability Representative/Attorney can also explain to you how a person can qualify for benefits under another person’s SSDI earnings. Check future posts on my site for more on this topic.

When a person’s monthly SSDI benefit amount falls below a certain amount (varies by state) then that claimant may also qualify for additional SSI. This means that the claimant may receive benefits from both programs.

Both SSI and SSDI have the same medical requirements for eligibility. There are condition listings for both adults and children. Many people are not going to fit into a specific category, so therefore the SSA will look at all the conditions to see if you or the child are functionally equivalent to a listing or would otherwise meet the medical criteria for disability.

Some diseases qualify you for automatic approval or expedited application processing. * See ssa.gov for more information. Search: TERI claims and Compassionate Allowance Claims.

Medicare/Medicaid

If you qualify for SSI you may also qualify for Medicaid.  If you qualify for SSDI, then you qualify for Medicare 24 months after the date SSA finds you to be disabled.

Medicare eligibility for recipients of concurrent benefits depends on your state rules.  You will want to contact your local Social Security office for more information.

Some diseases qualify you for immediate Medicare benefits. *

How are benefits paid?

If you are approved for SSDI the SSA will have determined the onset date of your disability.  You can get benefits going back to 17 months prior to your application date depending on your onset date. From your onset date you have a 5 month waiting period where no benefits are paid. For instance, let’s say you apply for benefits on April 4, 2012 alleging you became disabled on December 1, 2012 and SSA agrees and approves you in November 2012. Generally, you are eligible to receive benefits from June 2012 to present.  So, if all goes well with the payment processing (another process to be addressed, later) you should receive your first benefit payment in January 2013 for June 2012-December 2012.

If you qualify for SSI, then you get benefits going back to the month you applied. If you are due any retroactive benefits, your back award amount may be split into installments to be paid every 6 months.

If you qualify for SSDI and SSI concurrently, you are due your benefits for SSDI as described above as well as any back award and current for SSI. Your SSI back award could be paid separately, however, and possibly in installments.

How do Representatives and Attorneys get paid for helping a claimant?

A representative may charge you a fee for assisting you with your disability claim. Attorneys and representatives get paid ONLY if the claimant is approved AND the claimant is due retroactive/back award money. The representative generally can only charge 25% of the back award or $6000 whichever is less. Sometimes, a representative or attorney pays expenses for the claimant such as medical record copy charges and postage. These expenses may be charged to the claimant in addition to the fee. If the representative needs to charge a higher fee than standard, a special petition must be filed and approved by SSA and agreed to by the claimant. In any case, the SSA must approve any fee agreement between a claimant and her representative.  If a claimant has any concerns regarding the fee or fee agreement, she can request a review by the SSA.

Hopefully this information is useful.  I will be providing more information about specific topics presented to me by clients and colleagues.

* See ssa.gov for more information.

April L Roberts, ADR is an Accredited Disability Representative and operates a solo practice in Berea, OH Aaria Consulting^®, LLC. All Content is property of the author.