Tag Archives: Affordable Care Act

Some Observations On “Obamacare”

These health insurance/health care observations are written from the perspective of a common sense consumer. I am not in the insurance or medical business nor am I a politician. This article describes my current experience and deep frustrations with changes in the health care in America.

I have managed to buy health insurance since I got married in 1976. Ironically I sensed a duty to do so in the event my wife Brooksyne got pregnant (although as any who know us are aware she never did). We were both healthy and had no motive other than that but of course life is unpredictable at any age with accidents and diseases never expected. At that time I had no assets and really, as many did then and do now I could have been irresponsible and not paid the bill or strung it out having a financial load on us for years. At that time I am sure the premium seemed high and surely it was money we could have used for something else. After all, there’s always been something else to spend money on and things a lot more fun and interesting than paying an insurance premium.

The health insurance policy I have had for several years and which works fine for our family was cancelled effective 12/31/13. I understand many are getting the same letter

Why are we being deluded as if it’s only since we have the new Obamacare system people can finally get health insurance? At times I’ve had to buy individual policies such as when I first got married, at other times covered through a group policy as I had through many years of full-time pastoring and through a group plan in our district here in PA. The last several years it’s been an individual policy purchased directly through an insurance company (Highmark) when the district canceled the group plan.

Policies under the law that seem “compassionate” such as raising the age of dependents to 26, no lifetime limits and no exclusion for pre-existing conditions seem to me to throw the whole concept of “insurance” askew. Under these policies how can premiums not increase!  Also should we go to a single payer government run system as I and many others suspect is actually the goal of the left will we really have the unlimited lifetime benefits that are now imposed upon the insurance companies because it’s “compassionate”?

A look at these three expressions of “compassion”. (The three that I can think of, there may be more)

1. Raising age to be a dependent under the parent’s plan to 26. Surely this changes the likelihood the insurance will be used and this premium, often company-paid, will be raised. You are not getting something for nothing. As I recall this had been through 22 years of age or four years of college, the assumption being at that time you would get a job providing health insurance or be responsible and buy your own policy. Of course kids now go to college through their twenties getting advanced degrees and so forth. If 26 is compassionate wouldn’t 30 be even more compassionate? As Nancy Pelosi says let the young pursue their interests w/o having to worry about healthcare! But why 30? Be really compassionate and make children dependent for life. (Oh wait, better not give anyone any ideas!)
2. No lifetime limits. Using any degree of common sense how in the world can this work in a true insurance sense? New and ever more expensive technologies are always being developed and if there was no limit no telling what could be possible both to extend and improve life. When we go single payer be certain this no lifetime limit will not be applied at least for the common man although I would not be surprised if certain political types would see it!
3.  No denial for pre-existing conditions. On the surface this seems reasonable, compassionate and fair. It’s presented as someone who lost a job which had health insurance provided and then due to a pre-existing condition cannot get coverage. But in this case there is already Cobra, yes it’s very expensive but available. I just can’t imagine how the system will be gamed with this provision. Wait till you need insurance and then go for it, save the premiums in the meantime. Also as I recall there is higher premium policies already for people who have high blood pressure, cholesterol, etc. You just paid a higher rate. That’s the way all insurance works. However I do realize some are between a rock and hard place on this issue, who have sought to live responsibly and yet find themselves in a tough spot.

Why health insurance is needed:

1. Being able to pay your medical bills, which may be huge, unless you can self-fund. This should be a primary reason for a responsible person. A Biblical ethic is that we seek to pay our bills.
2. Protecting assets if you have a home, savings and other assets. If you don’t have any assets under the present system you still get care and then have to deal with massive bills you may never pay and they can’t imprison you for debt! I suspect many do this now. But we have sought to be responsible in life, owning our home and having some savings and retirement. W/O insurance this could be wiped out.
3. Based on my reading of the Explanation of Benefits (EOB’s) and an experience about ten years ago you don’t get the insurance negotiated rate if you don’t have insurance but rather pay the full “rack” price. Ten years ago I had surgery at Lancaster General Hospital. At that time I had a good Blue Cross/Blue Shield policy and prior to the surgery verified that LGH accepted the policy. However at that very time Blue Cross and Blue Shield separated and there was a short window that there was a lapse in coverage due to negotiations with some of the departments at LGH, which I found out later work independently of the hospital. Although my hospital and surgeon’s bill and other fees were covered two departments (anesthesiology and urology) did not have an agreement with Blue Shield in that short window (this affected many people in central PA for a several month period in early 2003). Turns out the top executive at the hospital at that time had a substance abuse problem and was on leave at this time and was later fired.  Although with good leadership all departments should have been required to accept the negotiated rate and they did so again about a month after my surgery. But the greedy business manager for the anesthesiology department insisted on the full rack rate, seeing this as an opportunity to gouge those caught in that window. He would not accept the negotiated rate which still would have been much more than the rate I would have paid if the insurance was working as it should have been. After several letters he sent the bill to collection and after having an attorney look the matter over and seeing what it would cost for him to intervene I just paid the bill of 3,000 dollars, although the negotiated rate would have been about $1200 as I recall and if the insurance was working as it should have been it would have been several hundred dollars. (The Urology department kindly accepted the negotiated rate.) The point is that having insurance, at least in my case, was needed to get the lower negotiated rate. I wonder how many that don’t have it at all are charged the full rate?

Ironically I see some merit in the concept of the individual mandate although I hate to see the government impose this. People should be responsible for their lives and prepare ahead. Presently many who could are just relying on government “compassion” to pay their bills which means many that are planning ahead actually end up paying their costs if they use healthcare. As mentioned above any of us can find a more exciting way to use our funds than paying insurance premiums. But I think there are other ways apart from forcing people to buy insurance although I haven’t thought through all the ramifications. For instance what if health insurance was strongly recommended and it was made known that if taxpayer funds were used to pay one’s medical bills due to failing to have insurance that the amount the government paid would be deducted from the paycheck until amount was paid. Of course this does not sound very compassionate! So many are conditioned that someone else richer should pay the bills.

Presently I pay my own health insurance premiums for a plan with relatively high deductibles, copays and co-insurance. I would sure rather use the money I pay for premiums ($1,041 per month in 2013) for something else, but it’s part of life. Many who have company paid health insurance are unaware how much this costs the company although some are now paying a portion and some companies inform what these costs are although many still would pay no attention to this. The health insurance premiums paid by the company are not taxable and the federal government presently gives those who pay for their own premiums a means of excluding these payments from the amount you pay federal income tax on. This does not apply to state and local taxes so self-payers do pay more in taxes than those who have company paid insurance. Of course a high end policy with low deductibles, copays and co-insurance is really valuable and I find it frustrating that salary comparisons usually don’t take this into account. For instance we are self-employed and offerings to our ministry and fees for our chaplain service comprise our gross income. From this we pay our ministry expenses as well as health care and retirement savings (when we are able to set aside funds aside for this).  What is left is the comparable equivalent for our “salary” in comparison to others who have company paid benefits. In 2012 that was $36,000.00 for our joint income which is $18,000 each yet thankfully we do well and don’t consider ourselves in need. I can’t fully explain why except we are thrifty and live a relatively simple lifestyle.

Why in the world is the healthcare.gov website such a big deal reportedly costing over 600,000,000 dollars! I suspect the amount of graft and corruption that went into this site is mind boggling. And of course that figure is probably way understated since it’s a government program!!! As mentioned above companies have been offering individual policies for years and already have websites and systems in place that actually work. Highmark actually has stores in our area. What’s more many insurance brokers are in business to sell insurance. (Private sector) Private websites typically work great and are far more complex than the healthcare website such as eBay and Amazon which surely handle millions of transactions daily and respond instantly such as eBay in bidding.

If they didn’t think people could manage to figure out how to get their own health insurance why didn’t they just develop a website that had links to insurance companies. As far as the “subsidies” based on income to help people afford it surely there’s a better way to handle this like a tax credit which would have utilized existing forms people are familiar with.

Like so many government programs even the bill’s official name is misleading (Affordable Care Act) with the word “affordable” yet many are seeing their rates go up and even more misleading is when the coverage is decreased such as higher deductibles. So even of your premiums do decrease the cost of your care will be higher.

I now understand that the mandate may be delayed for three months! That will work for those who do not have insurance and can delay. But I have insurance and want and need to keep it! Not having insurance and then having a major health issue could wreck or even wipe out many years of planning and saving.

Finally it really annoys me that anyone signing up for insurance through the website is counted as a score for the success of Obamacare. Wait a minute! My insurance was cancelled due to this law and now I must use the government website to get a policy. Based on my income I suspect I will be able to get a “subsidy” which I must use the site to get (unless someone corrects me). I wonder how many who have or will sign up are like me? It’s not an endorsement of Obamacare but rather a pragmatic way we are required to get insurance.

I suppose this remains to be seen but I wonder if premiums I pay for health insurance will be exempt from federal income tax as they are now. If not I just wonder how much of a net increase or decrease I will see even with the subsidy with higher premiums and deductibles and other costs.

Note: This article was written 10/29/13. Last night I tried to get on the healthcare.gov website and got this message:

The system is down at the moment.

We are experiencing technical difficulties and hope to have them resolved soon. Please try again later.

In a hurry? You might be able to apply faster at our Marketplace call center. Call 1-800-318-2596 to talk with one of our trained representatives about applying over the phone.

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