TIME White House

President Obama Sang the Davy Crockett Theme Song at an Event

"Is your name really Davy Crockett? That's a cool name"

When a man named James Davy Crockett asked the President a question at a town hall on Wednesday, President Obama had some questions of his own—and also, the urge to sing.

“Is your name really Davy Crockett? That’s a cool name,” Obama said. “But you don’t have that beaver cap?”

“I’ve got one at the house,” Crockett replied. (The frontiersman Crockett was actually known for a coonskin cap.)

Obama then recalled the Davy Crockett show that aired in the 1950s. “”Ya’ll remember that TV Show?” he asked the giggling crowd at Taylor Stratton Elementary School in Madison, Tenn. He then briefly broke into the show’s theme song.

The President’s exchange with Crockett began much more seriously—Crockett told the President he had unsuccessfully tried to get Social Security benefits, but had been turned down four times. Crockett’s story has been highlighted in the past, with an April Tennesseean article detailing his struggles with his health and gaining insurance. During Wednesday’s event, Obama promised to reach out to the Social Security Administration to get Crockett’s application expedited.

Obama took questions for about 50 minutes from a friendly crowd at the elementary school. He said his work on health care was not yet finished and thanked local leaders for their work in getting people in their states insured. The event followed the recent Supreme Court decision that kept the Affordable Care Act in place.

Watch a clip of Obama’s exchange with Crockett:

 

 

 

MONEY Kids and Money

Baby Proof Your Finances Before Becoming a Parent

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Sally Anscombe—Getty Images

7 things to plan for before your baby is born

Congratulations, you’re expecting! Now brace yourself: The cost of raising your newborn to age 18 has climbed to $245,340, according to federal estimates, and that’s before college costs. So use these months before the baby’s arrival to get ready for the financial challenges of parenthood.

Taking leave from work

Check if mom or dad’s employer offers any paid maternity or paternity leave. Only 12% of private-sector workers are entitled to paid family leave through their employer. Find out if you can supplement with vacation or personal days. Workers in California, New Jersey and Rhode Island can take advantage of state paid leave programs allowing for up to six weeks off with partial pay.

Next, consider unpaid leave, and whether you can afford it. You’re entitled to 12 weeks of job-guaranteed time off without pay under the Family Leave Act, as long as your company has 50 or more employees, you’ve worked there for at least a year (and 1,250 hours), and you live within a 75-mile radius of your workplace. Start planning now for how you’ll cover those weeks without a paycheck.

Things could change soon on the paid leave front. The Obama administration has earmarked $2 billion in federal funds for more states to develop family leave programs.

Planning for child care

Child care is a major budget item, often exceeding a family’s transportation, food and even college tuition costs. In 30 states plus the District of Columbia, the average annual expense of putting a baby in a day care center costs more than tuition at a state college, according to Child Care Aware. Charges can be as much as $14,508 for an infant or $12,280 for a 4-year-old.

Costs vary, so research the going rates in your area for large day care centers, home day care providers and nannies. Consider whether a relative is available to help, possibly for free or in exchange for other favors. Weigh child care costs against potential wages lost if either parent stays home with the baby.

Paying hospital bills

Although maternity and newborn care must be covered by health insurers under the 2010 Affordable Care Act, some older policies were grandfathered in without providing that benefit. This may be the case for younger mothers insured under a parent’s policy, for instance. So it’s a good idea to find out what your insurance pays for, what your deductible is and what you can do to hold out-of-pocket costs as low as possible.

Best to ask your insurer which health-care providers and hospitals are in your network, since going out-of-network may cost you a lot more. Check what prenatal tests are covered as well as the length of any hospital stay after delivery. Once you’ve chosen a hospital or birthing center, call the billing office ahead of time for an estimated bill and ask if there are unnecessary options you can decline to save money.

Budgeting for baby

With your estimates for medical bills, child care costs, and any unpaid family leave, you can start making a budget. This calculator from the U.S. Department of Agriculture helps figure what families with incomes similar to yours spend each year on major budget items. To keep costs down, resist the temptation to buy the latest baby gear; instead, look for gently used items to buy or hand-me-downs from friends and family, especially on expensive clothing, baby dressers or nursing gliders that will soon be outgrown or unneeded.

Build an emergency fund

Work on paying down any debt you may have so that your finances are as stable as possible before the baby arrives. Then prepare for the unexpected emergencies that tend to occur with a little one around. Try to stash away at least three to six months’ worth of living expenses so that you have a cash cushion.

Life insurance and estate planning

Life insurance protects your dependents by providing funds for immediate expenses if you should die, as well as money to replace the income that you would have earned. If you have a policy in place, double-check the beneficiary designation. Most parents name a spouse, who would use the life insurance money for taking care of the child. Or consider setting up a trust to benefit your child and naming the trust and trustee as beneficiary on the life insurance policy.

If you aren’t insured, lifehappens.org offers a calculator to figure out how much coverage you may need. Term life policies are generally less expensive and can serve parents’ purposes.

If you don’t have a will, you probably should make one, at least to designate a person to care for your minor child if you die. You can also designate a trustee to handle the child’s financial matters and an executor to pay your debts and manage your estate.

Take advantage of tax credits

Babies can bring tax breaks. The Child Tax Credit is worth up to $1,000 a year per dependent under age 17, depending on income. To qualify for the full credit, your taxable income must be $75,000 or less; $110,000 if married and filing a joint return.

You may be able to write off costs of child care that lets you work. The Credit for Child and Dependent Care can give back up to 35% of the costs, up to $3,000 for one child, or $6,000 for two or more. Expenses for babysitters, nannies, day care centers and after-school programs can all qualify for the credit.

Taking care of these financial moves before baby comes home will make you feel confident and in control as you embark on the adventure of parenthood.

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MONEY Medicare

How to Avoid Losing Out on Medicare If You’re Still Working at 65

Older workers need to watch out for these Medicare enrollment mistakes.

For anyone who plans to keep working after they turn 65—and that’s a growing number of people—planning for Medicare can be complicated. Last week’s column discussed the dizzying array of enrollment periods and other sign-up timetables for people who turn 65 and sign up for Medicare. In this column, I’ll explain the tricky transition from employer insurance to Medicare.

Roughly a third of Americans aged 65 to 69 remain in the work force—a rate 50% higher than only a decade ago. So the adage that everyone must get Medicare when they turn 65 is not true for more and more older Americans.

If you continue to work and have employer group health insurance, you probably do not need to sign up for Medicare. Also, if you lose employer coverage and do get Medicare, and then get a new job with employer health coverage, you usually will not need to keep Medicare. This often surprises people who think they must remain covered by Medicare for the rest of their lives once they get it the first time.

That said, there are exceptions and caveats to that general rule. So to avoid potential stumbling blocks, consider these three key guidelines:

Small business workers may need to sign up. If you’re about to turn 65, and you work for an employer with fewer than 20 workers, yes, you probably need to sign up. In these small-employer plans, Medicare becomes what’s called the primary payer of covered insurance claims for employees 65 and older. Your employer plan is the secondary payer.

If you fail to enroll, Medicare can deny you primary health insurance for many months. And when you finally do sign up, you often face premium surcharges that will last the rest of your life, which could cost you thousands of dollars. As a I mentioned last week, the initial enrollment window for Medicare lasts for seven months—three months before turning 65, the month you turn 65, and three months after your birthday month.

Check your employer’s Part D plan. For people working for larger employers, you don’t face this enrollment rule. However—and there are almost always howevers when it comes to Medicare—there’s a technical requirement for avoiding Medicare coverage, which could be a potential stumbling block to coverage.

Medicare requires that a person’s employer drug coverage be “creditable”—meaning that it must be at least as good as a Medicare Part D prescription drug plan. If that’s not the case, the person would need to sign up for a Part D plan. If you don’t, you will face lifetime premium surcharges for failing to do so on a timely basis.

How likely is it that your drug coverage would not be credible? Honestly, I have never gotten a reader question or spoken to anyone whose employer drug coverage was found to fall short. But if it did, the employee likely would not know until it was too late. Since it is a rule, employees approaching 65 should get confirmation from their human resource manager that your drug coverage passes this test.

Consider signing up for Part A anyway. Even if you do not need to enroll for Medicare at age 65, you should probably sign up for Medicare Part A, which covers hospital expenses and short-term stays in nursing homes. Part A premiums are waived for people whose work records qualify them for Social Security. Normally, this requires working 40 quarters in jobs where Social Security payroll taxes are paid.

Medicare Part A is a secondary payer in this scenario, which means it can help out with expenses not covered by employer group insurance. It does carry a steep-sounding deductible of $1,260 for each covered stay. But the cost of even brief hospital stays easily can soar to many multiples of this deductible, making Part A a nice benefit to have.

Signing up for Part A does have a big downside. By doing so, you will no longer be eligible to contribute to a tax-advantaged health savings account (HSA). If you have an HSA now, you will need to compare the potential benefit of Part A coverage with the loss of your ability to contribute to the account. If you choose to give up contributing to your HSA, however, you will still keep any accumulated funds for as long as you wish. And that money won’t be taxed if you spend it on qualified medical expenses.

Philip Moeller is an expert on retirement, aging, and health. He is co-author of The New York Times bestseller, “Get What’s Yours: The Secrets to Maxing Out Your Social Security,” and is working on a companion book about Medicare. Reach him at moeller.philip@gmail.com or @PhilMoeller on Twitter.

Read next: This Is the Biggest Mistake People Make When Signing Up for Medicare

MONEY Health Care

7 Smart Ways to Negotiate Your Medical Bills

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Jose Luis Pelaez Inc—Getty Images

One phone call can save you a bundle.

When you’ve just had a medical procedure, you should be concentrating on recovery — not how you’ll cover the bills. But what happens if you can’t make a payment? While you can’t make the bills disappear (unless you pay), you can probably reduce your financial burden if you know the right questions to ask. Get a leg up with these seven ways to negotiate your medical bills.

1. Learn to Spot Common Medical Billing Errors

I don’t want to suggest that medical bills purposefully contain errors, but sometimes honest mistakes do occur, and you need to know how to spot them.

“Every procedure performed by a health care provider has a code that allows the provider to bill your insurance company,” licensed health care attorney David J. Holt explains. “The issue with coding is that the average person has no idea what the codes mean.”

To catch you up to speed, Holt deciphers the definitions behind some those codes for you.

Upcoding

A medical bill that is improperly charged as a different treatment, typically a more expensive one. This is most common when a name-brand medication is billed for a generic medication.

Unbundling

Where services that should be packaged together are split and billed separately. This is common when multiple medical tests are ordered, but all relate to one medical diagnosis.

Duplicate Billing

This is more common than you would expect. This is where you are billed multiple times for the same procedure, perhaps 25 times instead of 23.

Mismatched Coding

This is when the treatment code does not match the diagnosis. In this situation, the insurance company then denies the claim. The bill is sent back to the provider and will either be corrected or sent down to you, the patient.

Balance Billing

This is the leftover balance after the insurance company pays. All of the charges may be covered under your policy, so you may not actually owe this “leftover” amount. Uncommon, but still happens with automated billing processes.

In effect, you should question all charges and make sure the bill lines up with the actual treatment. It’s important to be an educated patient.

Don’t be afraid to “call your biller and health care provider to determine what a bill and code mean,” Holt says. “It is your right as a patient and health care consumer to know what you are paying for.”

2. Go Into a Procedure Knowledgeable of Fees

While knowing what the codes and charges on your bills actually mean is important, so is knowing all the fees you’re incurring from your procedure. Because how will you know after the fact what’s legit, if you didn’t know beforehand?

There’s nothing wrong with raising these question in the initial stages. Cheryl Reed, a representative for Angie’s List, says the company has been advocating for years that patients need to be more empowered and bring their negotiating skills with them when they work with the medical community.

The first step is to get the quotes in writing. “If you’re price shopping before you have a procedure done, get a signature, name, and title to go along with the price quoted,” she says.

You also want to cover every doctor in the room.

“When getting prices, be sure you cover all fees associated with your procedure, rather than just the surgical costs — e.g. anesthesiologist, radiologist, laboratory costs, etc.,” says Reed.

3. Ask If You Qualify for Discounts

There are very few instances when I’m buying something that I don’t inquire about a discount. Many times it’s under-the-radar savings that I would never know about unless I speak up. Such is the case with medical bills. There are discounts available in some situations — all you’ve got to do is ask.

“The doctor I go to is part of a hospital network that automatically gives you 10% off if you pay the bill over the phone,” says Zina Zumok, whose frugal habits helped her pay off her student loans in full in three years. “You have to ask for the discount, but it’s an easy way to save money.”

Zumok also revealed another back-door tactic to lower the cost of medical bills — something called a charity care program, and it can save you big bucks if it’s available to you.

“A lot of people probably qualify for some kind of charity care program,” she says. “I applied for my doctor’s program and found out that I’m eligible for a 30% discount after what my insurance covers. The key to saving money on medical bills is to ask. Usually providers won’t tell you about any deals you can make. You have to be proactive and pursue any discounts you’re eligible for.”

4. Familiarize Yourself With Health Care Mumbo Jumbo

There’s a lot of insider jargon associated with health care and insurance companies in general, and my opinion is that they’re banking on you not knowing what much of it means, being too afraid to ask because you don’t want to look uneducated, and then taking their word for it. You’re doing yourself a major disservice by accepting your bills at face value. If you don’t understand any part of it, question it; your wallet might thank you.

Holt knows that this problem is all-too-common, as he’s dealt with plenty of patients who have fallen victim to it.

“How many Americans read through the entire health plan contract?,” he asks. “Not many, and not knowing the terms may lead to thousands of dollars in medical bills because you were unaware of your coverage. Don’t let this happen.”

Here are few prominent terms with which you should absolutely familiarize yourself.

Deductible

This is the amount that you pay out-of-pocket for health care before your insurance starts to pay. For example, for a $2,000 deductible, you would need to pay $2,000 before your health insurance would start covering costs.

Co-pay

This is a certain dollar amount associated with a type of care. For example, you may need to pay $25 for every visit to a doctor.

Co-insurance

This is similar to the co-pay, but in this case, there is a percentage you will pay for a certain type of care. For example, you may need to pay 30% of the cost for an outpatient surgery. Therefore, your insurance would pay the remaining 70%.

In Network vs. Out of Network

In-network refers to providers (hospitals/clinics) that are covered by your insurance and out-of-network means limited or no coverage by your insurance. Why doesn’t your health insurance cover all providers? It saves them on costs. Health plans contract with specific groups of providers for group discounts. Other providers are “out-of-network” and have different coverage rates, or are not covered at all. You should avoid out-of-network care if possible.

5. Visit the Hospital’s Billing Department

Spotted an error on your medical bill? Does something seem fishy? Don’t brush it off and resolve to pay it just to save time. Because if it happens once, it’s likely to happen again — and you need to nip that in the bud right away. Visit the hospital’s billing department in person to sort it out.

Another reason you may want to visit in person is if you’re having a hard time paying. Maybe there are no errors on the bill, but you just can’t afford the monthly payment. Instead of letting yourself go deeper into debt with late fees and other charges, have a one-on-one conversation about your financial situation with the source. You may be surprised by what you can work out.

Chicago-based RN and patient advocate Teri Dreher advises her clients to do the same.

“My tip would be to go to the hospital’s medical billing department directly if one is having a hard time paying,” she says. “Even if you pay a small amount every month, they will not give the payment to collections. It’s the person who does not pay at all that has the case go to collections.”

“If your economic situation improves after a few months, sometimes one can negotiate for a portion of the bill to be forgiven if the remainder is paid in full,” Dreher says. “I would also review the entire bill very carefully for accuracy as hospitals and physician offices often send out incorrect bills and charges. Accuracy is sometimes sacrificed for speed of getting the bills out.”

6. Be Polite, But Not a Pushover

You know the old saying: You catch more flies with honey than vinegar. That’s an important rule to remember when negotiating your medical bills. Being rude will get you nowhere. Be polite but persistent, and you’ll find the negotiating process much easier to manage.

Holt offers a few suggestions on preparing for the phone call with your biller.

“Don’t lose your composure on the phone; remain calm and objective,” he says. “The biller is taking notes on your conversation. Clearly communicate your financial situation. Say, ‘I am willing to pay something, but unable to pay the entire amount. Given my financial situation, what are the discounted payment options available for me?’ Offer to pay a discounted percentage of the bill up front (say $100 today for a $500 bill). Hold strong here. Request for the payment terms to be as long as possible. Generally, you will have a maximum of two years from the original billing date to pay off your bill. Request an ‘interest-free payment plan’ for a discounted amount of the total bill. Health care providers are getting clever about collecting debt and offering all sorts of ‘low interest medical-credit’ plans. In reality, this is just a credit card with the health care provider. Since when did my health care provider also become my banker? I do not feel like that is right.”

In other words, avoid the medical credit plan option at all costs; it’s likely to cost you much more in the long run. Try to find a way to pay the bill down without accruing any more fees. If you can’t afford the cost of the bill now, you definitely can’t afford to start tacking on high interest fees to lower a monthly payment.

7. Call an Expert for Help

If you feel completely ill-prepared to negotiate your own medical bills, there are experts out there who can help you. These experts aren’t free, of course, so you really need to weigh your options before calling in the big guns. Will these additional fees that the experts charge break even after the negotiations? It’s hard to tell, so it’s wise to proceed with caution in this area.

Nonetheless, Reed points out that these reviewed and trusted experts can be found on Angie’s List.

“Medical billing is so complex that it’s spawned a new industry of professional bill reviewers, sometimes called patient advocates,” she says. “These specialists, who are rated on Angie’s List, are trained to look for incorrect billing codes and duplicate charges. Experts say advocates can recover 17% to 49%, and charge an average contingency fee of about 30%. Some charge flat fees, as well.”

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MONEY Health Care

Here Are the Top-Selling Drugs in the US

Picture taken on January 15, 2012 in Lil
Philippe Huguen—Getty Images

The top-earning prescription drug brought in nearly $8 billion in 2014.

Prescription drugs are a vital part of American health, helping millions every year with their health conditions. About half of all Americans take a prescription drug regularly, and about 1 in 5 U.S. adults takes three or more regular prescription drugs, according to the Centers for Disease Control and Prevention.

But these medications are also a vital part of our economy, for better or worse. Collectively, we spent nearly $374 billion on prescriptions in 2014, according to the latest report by IMS Health Informatics, a company that tracks health care spending. That amount is about equal to Walmart’s profits in 2008 or the entire gross domestic product of Austria in 2009.

We’ve already shared with you the most widely prescribed drugs, but none of those makes the most money. So which drugs were the top earners in 2014?

  1. Sovaldi, $7.9 billion
  2. Abilify, $7.8 billion
  3. Humira, $7.2 billion
  4. Nexium, $5.9 billion
  5. Crestor, $5.8 billion

Uses for the top-selling drugs

The top-selling drugs treat different ailments, and all are brand-name drugs, meaning there were no generic options for them in 2014. That may be why they top the list in sales; generic drugs are typically much cheaper than branded drugs. Here’s what the top-selling prescriptions are used for.

  • Sovaldi was first approved for most types of hepatitis C in 2013 and quickly skyrocketed to the top earnings spot in 2014. There are six genotypes of hepatitis C, and Sovaldi can cure four of them in one or two treatment courses; the other two genotypes account for about 3% of hepatitis C patients. Manufacturer Gilead boasts an 84% to 96% cure rate of hepatitis C, depending on which genotype is being treated, leading many to call Sovaldi a miracle drug.
  • Abilify is a medication for depression, bipolar disorder, and schizophrenia. Officially classified as an antipsychotic, Abilify also treats irritability associated with autism. In April 2015, the first generic for Abilify, aripiprazole, became commercially available.
  • Humira is a biologic drug, which means it’s synthesized from animal tissues or cells instead of from chemicals. It’s indicated for eight conditions, including Crohn’s disease, plaque psoriasis and several types of arthritis.
  • Nexium is approved to treat frequent acid reflux, stomach ulcers, damaged esophagus and gastroesophageal reflux disorder (GERD). In January 2015, the Food and Drug Administration approved the first generic Nexium drug, esomeprazole, so it may not make this list next year.
  • Crestor is the only statin on our list, approved to treat high cholesterol and triglyceride levels. It also may reduce the risk of heart attack and stroke in some high-risk patients.

Cost of the top-selling drugs

These five drugs aren’t among the most widely prescribed, so their high prices explain why they made so much money for their manufacturers last year. Drug prices also vary depending on which pharmacy and dose you use, your health insurance policy and how much you purchase at once, among other factors.

Here are some cash price estimates for one month of common doses of each of the five drugs based on GoodRx searches in San Francisco. For comparison, we’ve also included the prices of the two generics that are now available for the same doses and time frame. Keep in mind that your price will depend on on your insurance formulary, or list of approved medications for coverage, and out-of-pocket costs outlined in your policy.

  • Sovaldi: $30,700 – $31,900
  • Abilify: $921 – $954
    • Generic Abilify, aripiprazole: $371-$682
  • Humira: $3,305 – $3,408
  • Nexium: $252 – $273
    • Generic Nexium, esomeprazole: $103 – $199
  • Crestor: $219 – $225

Bear in mind that the first drug, Sovaldi, is not intended for chronic use, but rather only for three to six months in one lifetime. Sovaldi costs about $84,000 for an average 12-week course of treatment, and some patients require two courses, for a whopping price tag of $168,000. Humira also has a caveat: It requires a larger dose to start before going to maintenance dosage, which will cost more. Only maintenance doses are quoted above.

Saving on the drugs

All this price variation can be a big problem if you’re using one of these drugs. If you’re paying cash for your medications, consider looking into coupons on a site like RxRevu or the manufacturer’s website, which also may have longer-term discount programs. The price ranges are based on different pharmacies, so where you choose to fill your script can make a difference of hundreds or thousands of dollars.

You can also save on your medications by going through an online pharmacy. By allowing you to purchase a larger supply, online pharmacies can offer substantial discounts. If you need more help, you can check out the U.S. Department of Health and Human Service’s listing of prescription assistance programs.

Lastly, if you take a drug such as Abilify or Nexium for which a generic is available, talk to your doctor about switching to the less expensive option. Generics are required to be just as safe and effective as branded drugs, and they must meet the same quality standards. According to the FDA, generics cost about 80% to 85% less, on average, than their pricey brand-name counterparts.

Don’t be afraid to ask your doctor questions about any cost issues. It is always OK to ask about generics, or any other cost-saving options you might find.Whether it’s for drugs, medical procedures, or finding the right doctor, doing your homework and shopping around is a great way to start saving money.

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MONEY Health Care

Obamacare Still Has 5 Key Hurdles to Clear

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Peter Dazeley—Getty Images

Despite the Supreme Court ruling upholding it, the Affordable Care Act still has a rocky road ahead.

In its first five years, the Affordable Care Act has survived technical meltdowns, a presidential election, two Supreme Court challenges — including one resolved Thursday — and dozens of repeal efforts in Congress. But its long-term future still isn’t ensured. Here are five of the biggest hurdles remaining:Spacer

1. Medicaid Expansion. About 4 million more Americans would gain coverage if all states expand the state-federal Medicaid programs to cover people with incomes at or slightly above the poverty line. Twenty-one states with Republican governors or GOP-controlled legislatures, including Texas and Florida, have balked, citing ideological objections, their own budget pressures, as well as skepticism about Washington’s long-term commitment to pay for most of the costs.

2. Anemic Enrollment. Eighteen million Americans who are eligible to buy insurance in federal and state marketplaces haven’t purchased it. Those marketplaces have had particular trouble enrolling Hispanics, young adults and people who object to being told to buy insurance. Federal funding used by state marketplaces to enroll people and advertise is drying up. Many state marketplaces haven’t figured out how to be self-sustaining. Vermont, Hawaii, Colorado and Rhode Island are among those states searching for more money. The penalty for going without coverage rises next year to $695 per adult or 2.5% of family income—whichever is larger.Spacer

3. Market Stability. Nationally, premiums haven’t gone up too much on average in the first two years of the marketplaces, but that could change. The federal government has been protecting insurers from unexpectedly high medical bills, but that cushion disappears after next year. At the same time, insurers finally have enough experience with their initial customers to figure out if their premiums are sufficient to cover medical costs. If they’re not, expect increases.Spacer

4. Affordability. People who get their insurance through their employer have mostly been spared jolts from the health law. But the federal government begins taxing expensive health plans in 2018. The “Cadillac tax,” created by the health law, will pressure employers to offer skimpier health coverage or pass the taxes’ cost on to their employees. Also, individuals buying their insurance on the health law marketplaces continue to risk large out-of-pocket costs if they need lots of care. Their maximum financial obligations for next year are $6,850 for individuals and $13,700 for families. Those who choose to go out of their insurance network may have no ceiling on how much they may have to pay.

5. Political Resistance. Thursday’s ruling did little to diminish the GOP’s zeal to repeal the health law. Republicans on both sides of the Capitol pledged to continue their efforts to kill the ACA. Alawsuit filed by House Republicans last year alleges the president overstepped his authority when implementing the health law. The topic remains grist for the 2016 presidential campaign, with several Republican presidential candidates – including Sen. Lindsey Graham, R-S.C., and former Florida Gov. Jeb Bush — reiterating their desire to repeal the law. If the Republicans capture both the White House and Congress in 2016, all bets are off over whether the law survives intact.

Kaiser Health News writers Julie Appleby, Mary Agnes Carey, Phil Galewitz and Jordan Rau contributed to this report.

Kaiser Health News (KHN) is a nonprofit national health policy news service.

MONEY Social Security

This Surprising Sign May Tell You When to Claim Social Security

old woman facing younger woman in profile
Liam Norris—Getty Images

For aging Americans, the condition of your skin can be a barometer of your overall health and longevity.

Skin is in, and not just for beach-going millennials. For boomers and older generations, the condition of your skin, especially your facial appearance, is a barometer of your overall health and perhaps your life expectancy, scientists say. And as the population ages—by 2020 one in seven people worldwide will be 60 or above—dollars are pouring into research that may eventually link your skin health to your retirement finances.

What does your skin condition have to do with your health and longevity? A skin assessment can be a surprisingly accurate window into how quickly we age, research shows. Beyond assessing your current health, these findings can also be used as to gauge your longevity. This estimate, based on personalized information and skin analysis, may be more reliable than a generic mortality table.

All of which has obvious implications for financial services companies. One day the condition of your skin—your face, in particular—may determine the rate you pay for life insurance, what withdrawal rate you choose for your retirement accounts, and the best age to start taking Social Security.

Skin health is also a growing focus for consumer and health care companies, which have come to realize that half of all people over 65 suffer from some kind of skin ailment. Nestle, which sees skin care as likely to grow much faster than its core packaged foods business, is spending $350 million this year on dermatology research. The consumer products giant also recently announced it would open 10 skin care research centers around the world, starting with one in New York later this year.

Smaller companies are in this mix as well. A crowd funded start-up venture just unveiled Way, a portable and compact wafer-like device that scans your skin using UV index and humidity sensors to detect oils and moisture and analyze overall skin health. It combines that information with atmospheric readings and through a smartphone app advises you when to apply moisturizers or sunscreen.

This is futuristic stuff, and unproven as a means for predicting how many years you may have left. I recently gave two of these predictive technologies a spin—with mixed results. The first was an online scientist-designed Ubble questionnaire. By asking a dozen or so questions—including how much you smoke, how briskly you walk and how many cars you own—the website purports to tell you if you will die within the next five years. My result: 1.4% chance I will not make it to 2020. Today I am 58.

The second website was Face My Age, which is also designed by research scientists. After answering short series of questions about marital status, sun exposure, smoking and education, you upload a photo to the site. The tool then compares your facial characteristics with others of the same age, gender, and ethnicity. The company behind the site, Lapetus Solutions, hopes to market its software to firms that rely heavily on life-expectancy algorithms, such as life insurers and other financial institutions.

Given the fledgling nature of this technology, it wasn’t too surprising that my results weren’t consistent. My face age ranged between 35 and 52, based on tiny differences in where I placed points on a close-up of my face. These points help the computer identify the distance between facial features, which is part of the analysis. In all cases, though, my predicted expiration age was 83. I’m not taking that too seriously. Both of my grandmothers and my mother, whom I take after, lived well past that age—and I take much better care of my health than they ever did.

Still, the science is intriguing, and it’s not hard to imagine vastly improved skin analysis in the future. While a personalized, scientific mortality forecast might offer a troublesome dose of reality, it would at least help navigate one of the most difficult financial challenges we face: knowing how much money we need to retire. A big failing of the 401(k) plan—the default retirement portfolio for most Americans—is that it does not guarantee lifetime income. Individuals must figure out on their own how to make their savings last, and to be safe they should plan for a longer life than is likely. That is a waste of resources.

I plan to live to 95, my facial map notwithstanding. But imagine if science really could determine that my end date is at 83, give or take a few years. It would be weird, for sure. But I’d have a good picture of how much I needed to save, how much I could spend, and whether delaying Social Security makes any sense. I’m not sure we’ll ever really be ready for that. But not being ready won’t stop that day from coming.

Read next: This Problem is Unexpectedly Crushing Many Retirement Dreams

MONEY Health Care

What is Obamacare?

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Robert A. Di Ieso, Jr.

Here's how President Obama's health insurance reform law actually works

Today, there’s been a lot of talk about the Supreme Court’s latest ruling on the Affordable Care Act, better known as Obamacare. But while the law signed by President Obama in 2010 made huge changes to the health insurance system, most people under 65 still get their coverage the way they always did: from their employer. Unless you bought a health insurance plan on a government-run marketplace, you might not be familiar with how the ACA provides coverage. Here are answers to some common questions:

How does the law help people get insurance?

The law set up insurance “exchanges” that offer consumers and small businesses a choice of standardized and heavily regulated health plans. For the most part, this marketplaces serve people who aren’t offered insurance by a large employer.

And how is that different from the way people bought their own insurance before?

On the exchanges, insurers are not able to turn anyone down because of a pre-existing condition; from pregnancy to heart disease, they’re all covered. The law also restricts or blocks annual and lifetime limits on what insurers, including in employer plans, will pay.

Rates aren’t tied to your health, although smokers may have to pay up to 50% more. The oldest people in a plan will pay no more than three times the rate paid by the youngest. In short, policies you buy yourself will be a lot more like the group plans you get at work.

What does coverage cost?

The insurance on the exchanges isn’t free—a family of four could well face annual premiums of $10,000 a year. But many of those using the exchanges will also receive federal subsidies—technically, tax credits—to help them buy. Those subsidies reach deep into the middle class: For families earning up to four times the poverty line—about $95,000 for a couple with two kids—the tax credits will be set so that they pay no more than about 9.5% of their income for a fairly basic health plan. (That cap is designed to rise gradually should premiums grow faster than incomes.)

People with lower incomes pay even smaller percentages. Some pay almost nothing.

The law was also meant to allows millions of the near poor to join Medicaid through the exchanges, although a Supreme Court decision left it up to individual states whether to participate in the expansion. Currently, 21 states are opting out.

What kind of coverage can I get?

All the plans must provide at least a standard menu of essential benefits. They come in four basic types: bronze, silver, gold, and platinum.

Although plans can compete by mixing different premiums, deductibles, and co-pays, you’ll know the average level of out-of-pocket costs you can expect in each type. For example, the silver plans ask you to pay about 30% of your costs out of pocket. (Subsidies are based on the cost of the silver plans.) The more expensive platinum plans, which would be most similar to a large employer’s coverage, would have out-of-pocket costs of just 10%.

How is all this paid for?

In a number of ways, but the most direct one is that high earners got a payroll tax hike. Starting in 2013, couples have paid additional taxes on earnings above $250,000 ($200,000, if you’re single)—0.9% on earned income and 3.8% on investment income.

Why are some people fined for not buying coverage?

By 2016 you’ll be dunned $695 a year or 2.5% of your income, whichever is higher, if you don’t have health insurance. However, there’s an exemption if premiums top 8% of your income. Insurers fought for this provision. Even with subsidies, some people may decide that coverage is too expensive. They’ll tend to be healthier than average—that’s why they’d be willing to take the risk. But that poses a problem in a system where insurers have to take all comers. If healthy people drop out, the pool of people paying in will typically be sicker and more expensive to treat. That causes premiums to rise, which causes more healthy people to drop out, which means higher premiums, and so on. To prevent this “death spiral,” the law pushes people to buy.

Adapted from “The Truth About Health Care Reform,” which appeared in the May 2010 issue of MONEY.

MONEY Health Care

Here is How Much the Government Will Pay to Help You Buy Obamacare

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Getty Images

The Supreme Court decided that health care subsidies should remain available to everyone who buys Obamacare plans

Today the Supreme Court decided that Americans who buy health insurance on Healthcare.gov are eligible for subsidies to help them pay their premiums.

The decision shines a bright light on the oft-forgotten linchpin that holds the sweeping 2010 health care law together: The federal government is handing people significant amounts of money to pay their premiums.

Under the Affordable Care Act, popularly known as Obamacare, those who don’t have health insurance can buy plans on government-run marketplaces or “exchanges.” States may either set up their own marketplaces or opt to use the federal government’s marketplace, available on Healthcare.gov. Then, the government provides subsidies to help people afford the healthcare premiums.

The court case was about whether the law said the subsidies applied in states that didn’t set up their own exchanges. (The argument was over how to read one clause in the legislation.) The Supreme Court decided that health care subsidies should remain available to everyone who buys Obamacare plans.

The subsidies make a huge difference to the people who receive them: On the federal exchange, they’re worth an average of $272 a month.

Use this calculator from the Kaiser Family Foundation to see how much an Obamacare plan would cost you, and how much is covered by the subsidies:

And a lot of people qualify: 87% of people who bought Obamacare plans on the federal exchange got a subsidy. Anyone who makes up to 400% of the poverty line is eligible. In 2015, families of four that earned $95,400 made the cutoff.

Policymakers will continue to debate whether the subsidies are accomplishing the goal of making health care affordable. The Government Accountability Office recently found that subsidies “likely contributed to an expansion of health insurance coverage in 2014.” But it’s not like health insurance premiums are cheap, even with financial assistance from the government. After all, Americans who get health insurance at work pay less, on average: $90 a month for single coverage, according to the Kaiser Family Foundation. That’s up from just $27 a month 15 years ago.

And by the way, workplace coverage is (indirectly) subsidized by the government too, in the form of a tax break that makes it very attractive for companies to offer.

TIME Supreme Court

Supreme Court Rules That a Typo Should Not Undo Obamacare

Justices ruled by a margin of 6 to 3 that the intent of Congress was clear enough to override contradictory language in law itself.

In the end, an apparent legislative typo did not bring down Obamacare.

President Obama’s signature health care law survived a second challenge at the U.S. Supreme Court Thursday, with the Justices ruling by a margin of 6 to 3 that the intent of Congress was clear enough to override contradictory language in law itself.

The decision was a major win for Democrats and the President, who would have faced the difficult task of negotiating a fix to the law with Republicans had the court decided that a specific clause in the law invalidated tax subsidies for millions of Americans. That negotiation could have resulted in either a collapse of the health insurance reforms in a majority of states, or a significant paring back of their reach.

At issue was a clause in the law that stated that federal tax subsidies for health insurance purchases were only available in insurance marketplaces, known as exchanges, that had been set up by states. The court had been asked to decide whether the plain meaning of that clause invalidated subsidies for the 34 states, and about 6.4 million Americans, who received subsidies after buying healthcare through an insurance marketplace operated by the federal government. Democrats argued that the clause was little more than a typo made in the rush to enact the law.

The court ruled that the full context of the law made clear that Congress had not intended to bar subsidies for insurance purchased on the federal exchanges. “It is implausible that Congress meant the Act to operate” as challengers of the law had argued, Chief Justice John Roberts wrote in his decision.

“The tax credits are among the Act’s key reforms, involving billions of dollars in spending each year and affecting the price of health insurance for millions of people,” Roberts continued. “Whether those credits are available on Federal Exchanges is thus a questions of deep ‘economic and political significance’ that is central to this statutory scheme; had Congress wished to assign that question to an agency, it surely would done so expressly.”

In an aside, the Chief Justice chided Congress for sloppiness in writing the law. “The Affordable Care Act … contains more than a few examples of inartful drafting,” Roberts wrote.

The three most conservative Justices on the court, Antonin Scalia, Samuel Alito and Clarence Thomas, wrote a bristling dissent to Roberts, suggesting that the court majority could not read the plain language before them. “You would think the answer would be obvious—so obvious there would hardly be a need for the Supreme Court to hear a case about it,” Scalia wrote.

They argued that by deciding to give more weight to the context of the entire law than the plain language of a specific section, the Supreme Court was effectively rewriting the law. “Our only evidence of what Congress meant comes from the terms of the law, and those terms show beyond all question that tax credits are available only on state exchanges,” Scalia wrote, citing the specific passage. “More importantly, the Court forgets that ours is a government of laws and not of men. That means we are governed by the terms of our laws, not by the unenacted will of our lawmakers.”

Scalia also added a rhetorical flourish to his dissent typical of his more animated opinions. Using an acronym for the Supreme Court of the United States, he suggested taking the President’s name out of the common vernacular for his signature law. “We should start calling this law SCOTUScare,” Scalia wrote.

But such jibes were not enough to sway a strong majority of the court. “In a democracy, the power to make law rests with those chosen by the people,” Roberts concluded in his opinion. “Our role is more confined—’to say what the law is.’ That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. ”

 

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