(Continued from Parts One, Two, Three, and Four)
After over eighteen hundred words complaining about my current health insurance coverage, I would like to clearly and unequivocally express my gratitude that I have an employer that pays a large portion of my premiums in addition to providing a moderate yearly contribution to my HSA; I would also like to show my gratitude that my husband’s employer provides a small reimbursement for his coverage too, and that we can still afford to pay for the remaining premiums. I have many family members and friends that are uninsured because they either work for an employer that doesn’t provide coverage, they cannot afford coverage on the individual market, or they are looking for employment after losing the jobs which provided their coverage.
Although I haven’t read the Patient Care and Affordable Care Act, I have listened to numerous podcasts and read ample articles discussing the law. Like most Americans, I like that health insurance companies can no longer non-renew policies after subscribers get sick. I’ve never thought making people wait for their pre-existing conditions to have coverage is overly unfair because this is generally a twelve to eighteen month waiting period only if there was a lapse in coverage, but now this will eventually be eliminated; however, I recently discovered that even if one maintained continuous coverage with an individual policy but didn’t carry maternity coverage that the maternity coverage could neither be added nor could one purchase a new policy to provide maternity coverage without a waiting period. I’ve always had a problem with the discrepancies between group and individual coverage, and after 2014 individual policies will be treated more like group policies in that age, gender, and location are considered when calculating the premium not whether someone has ever taken medication to treat anxiety or depression. Another favorite provision is that all health plans will eventually pay for preventive care without any co-pay or deductible (this is already in effect for plans purchased after September 2010, but won’t begin for current plans until 2014), although whether the global billing package will come into play or not isn’t clear (in fact the section on pregnancy at healthcare.gov sounds suspiciously like my current health insurance policy). Finally my favorite provision is that all those elected officials who are trying to repeal healthcare reform and who proclaim that American healthcare is the best in world will no longer have government provided healthcare after 2014.
Insurance only works when the risk is spread over a large pool of people, and without a strong incentive to purchase coverage young and healthy people would continue to not carry insurance (this is why I don’t think waiting periods for pre-existing conditions is entirely wrong). It is inappropriate to call the provision an individual mandate, as it is one’s option to either purchase insurance or pay a tax, which frankly will probably be less than obtaining insurance coverage in most instances. Numerous studies have shown that the uninsured do not obtain preventive care, receive less treatment after diagnosis, and have a higher mortality rate than the insured. They often receive their care at free or low cost clinics or emergency rooms or urgent care centers, and while these places provide valuable services, they are not a substitute for regular check-ups and treatment.
However, I do not like the fact that the law doesn’t firm price controls while pushing large numbers of people into the private market or even establish a state by state standard of usual and reasonable cost index for care (my greatest difficulty with my HSA has been to find out the cost of care prior to obtaining care). In North Carolina, if you wish to obtain a driver’s license you must first obtain automobile liability insurance, and no insurance company can refuse to write a liability policy for any driver that can provide proof of North Carolina residency regardless of their driving record. This works because the state has a reinsurance facility, which is funded by a surcharge to every single auto policy written in North Carolina; the insurance companies then send all the high risk policies to this pool. If you are a high risk driver and need to have collision, no company is required to provide the coverage, but most companies will provide the coverage because again they can send the policy to the high risk pool. The state sets the maximum auto rates as well as approving what discounts and rate reductions each company can provide; a high risk driver must agree to pay higher than the state rates to obtain collision coverage.
This model seems to work fairly well for all parties in the state, and I wish the healthcare law had enacted something similar. A basic policy would be required to be issued, and a maximum rate for this coverage would be set. The basic policy would cover preventive care along with a few sick visits and generic prescription drug coverage with some out of pocket costs, and it would be the same basic policy with every insurer (like the North Carolina auto policy). Each company could offer enhancements and of course charge for those, but again there would be a maximum rate any company could charge for any policy.
Although the health insurance exchanges are purported to be the best way to control cost, I fear that the sick will be pushed to exchanges exclusively with the young and healthy primarily insured outside of the exchanges. This is sure to bring about failure of the exchanges if they are heavily loaded with those that are more expensive to insure. I also don’t like that even though the insurance companies are about to get an influx of customers the federal government is going to be subsidizing the high risk; why can’t the health insurance companies use their increased profits with their broader customer base to fund the high risk pools?
I also like that an excise tax will be levied against drug companies to help pay for the healthcare bill, but I really want to see an end to prescription drug commercials in all media. As doctors have the power to prescribe, the advertising should be limited to that population. If a patient wants to explore treatment options access to medical journals is open and available. I loathe how much money is spent on those incessant commercials when public funds contributed to their research and development only to have private companies then hold patents for years to ostensibly recoup their development costs.
Even after all this thought, I am still undecided as to whether I will continue with the HSA or not; if I move back to the traditional plan I will no longer get my little bonus from my employer, and we’ll still have some fairly large out of pocket expenses if I get sick. I have quoted policies for the little one, and if we do an HSA with a $5,000 deductible the premiums will be less than $100 a month, but a traditional plan without huge out of pocket expenses it will be over $200 a month for a newborn that doesn’t smoke or drink or engage in other destructive behaviors. However, if we decide on a plan for the little one and my honey we can have a $10,000 deductible with no co-insurance for about the same monthly premiums we are paying now, and as we will be purchasing this policy later this year, thanks to the Patient Protection and Affordable Care Act, preventive care is fully covered even in a traditional health policy.
I am interested to see how all of this plays out between now and 2018 when the final provisions of the bill become effective, and I will strenuously protest anyone who dares to repeal this law without codifying virtually all of its patient protections and adding a cost ceiling. If it survives beyond 2014, I will be rather interested to see how those who praise American healthcare as the best in the world are dealing with being on the private market rather than on the free government provided care they currently have.