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Health insurance policy with $100 bills.
Generous health benefit plans with low deductibles and co-pays are a thing of the past, as employers curtail the health insurance benefits they offer to be sure of avoiding the "Cadillac tax"—the high excise tax companies could be hit with under the Affordable Care Act. The intent of the tax was to bring down health care costs by making individuals more aware of and more responsible for what they're spending, to force them to forego expensive tests and procedures and too-frequent usage. It's the vaunted "skin in the game" theory of shifting costs. The problem is, not everyone with a "Cadillac" plan is actually a Cadillac kind of person.
The changes can be significant for employees. The hospital where Abbey Bruce, a nursing assistant in Olympia, Wash., worked, for example, stopped offering the traditional plan that she and her husband, Casey, who has cystic fibrosis, had chosen.

Starting this year, they have a combined deductible of $2,300, compared with just $500 before. And while she was eligible for a $1,400 hospital contribution to a savings account linked to the plan, the couple is now responsible for $6,600 a year in medical expenses, in contrast to a $3,000 limit on medical bills and $2,000 limit on pharmacy costs last year. She has had to drop out of school and take on additional jobs to pay for her husband’s medicine.

Here's where one of the primary problems with the Affordable Care Act is exposed: While it might reduce health care spending, for many people it doesn't reduce the cost of care. If you're healthy and only need to see the doctor for annual physicals, it's great: You get preventive care without any copays. But if you've got a serious health issue that requires frequent care and expensive prescriptions, you could be spending a lot more. Of course, if you have a serious health issue and were previously uninsured because of your pre-existing condition, you can at least get insurance now.

This is where Obamacare just starts, though. It's not enough to reduce health care spending by forcing consumers to either go without, or through cost-shifting. The actual health care they receive needs to be made less expensive. That's where the next steps in reform have to be made. It's time for providers to put their skin in the game, too.

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Originally posted to Joan McCarter on Tue May 28, 2013 at 01:32 PM PDT.

Also republished by Daily Kos.

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