I was a staunch supporter of the Affordable Care Act. I loved the immense possibilities of providing healthcare to everyone. It wasn’t a one-payer system but the prospect of everyone having health insurance made me giddy. As a patient advocate, I had visions of sugar plum fairies dancing in my head.
I am afraid my dreams have become nightmares. What I see are three problems. First, because the Republicans are so determined to repeal the law, they refuse to fix any parts of it. How many times has the house voted to repeal the act? Over 100?
Second, as a result of no fine-tuning of the act, the insurance companies have had a field day. The burden of cost is slowly being shifted to the consumer not just in terms of premiums but also for coinsurance, deductibles and co pays. The plans are mostly HMOs limiting provider choice with no out of network reimbursement. When provider choice is limited, it becomes a quality of care issue. The consumer is loosing the battle for input and control.
Finally, the middle class is taking the brunt of cost. Once a consumer falls out of the subsidy levels, there is nothing but high premiums and increased costs.
I recently moved to Washington. In the past, I either had insurance from my employer or my husband’s. We discovered that his new employer did not pay for family. I could get insurance through his company but had to pay full price.
That led me to the Washington exchange for possible options. Foolish me, I thought I would find wonderful plans for a good price. I was stunned at the plans offered and the cost. As usual and expected, the lowest premiums had the highest deductibles, coinsurance and were strict HMOs. As I scrolled through the different levels of Gold, Silver and Bronze, the cost rose dramatically and the plans didn’t change that much. Yes the deductible and coinsurance dropped some but for the knowledgeable consumer, the cost just shifted. There was no saving.
The cheapest plan was over $400 with a $5,000 deductible and 30-40% coinsurance. There were separate hospital deductibles. The physician network was limited and confusing. The highest premium was over $1,000 with at least a $1,000 deductible and 20-30% coinsurance.
What this all translates into for someone who understands insurance plans is; if I took the lowest premium plan and had an emergency and was hospitalized, I would be paying the hospital deductible, the regular deductible and 30% of any bills. Since most hospitalizations run anywhere from $12,000 and up even overnights and with the contracted amount, I would have a hefty bill sent to me.
If I went with the higher premiums, I would have to pay the insurance companies about $12,000 a year plus the deductible plus the coinsurances. A hospitalization would still generate a large bill.
What came to mind while I was lamenting about the state of affairs was Medicare Part B which is the outpatient insurance for the over 65 gang and/or disabled. The consumer pays $110/ month and Medicare pays 80% the individual is responsible for 20%. To offset this expense, Medicare supplemental and Medicare advantage plans were created. These plans pick up the 20% if Medicare has approved the 80%.
That works well. Do we need supplemental insurance to cover the coinsurance? It is truly a travesty that the insurance companies and the politicians are allowing this to happen. People are still spending large chunks of income on healthcare, especially the middle class.
I ended up going with my husbands plan till open enrollment. I am hoping the options may change. What ever happens, my healthcare costs will be high.