The pods and nets and air and tubes and plasmas and liquid crystals are full of horror stories, success stories, dismisinformation, and all ilk as it relates to the Affordable Care Act. This is one opinionated comment about the impact of the ACA on two people employed in a dying profession and how it makes their lives better.
My plea to all people, but most forcefully to the “my-premiums-went-up” whiners, please include some kind of tangible, graspable, factual information when ranting for or against the ACA. YOUR life isn't MY life and until we have a single-payer system, insurers will still have some wiggle room for price discrimination based on age and life-situations, especially if your stuck in an employer sponsored plan. So I hope you can see that maybe the specifics that dictate the cost of YOUR plan are not the same for MY plan. Maybe something other than the ACA has changed the dynamics of your coverage. Maybe your plan has become much more than catastrophic coverage. Maaaybe you have been gambling with your health and/or your families health by under-insuring and hoping nothing bad happens. Who knows, until you provide some specifics everyone else has to take your word that your situation is better or worse.
My wife and I work as Lutheran Ministers. Our family is younger and healthier then our employer's risk pool. We have always had higher insurance costs because of this discrepancy. Now we are going to be rewarded for our healthy choices in diet and exercise. Starting Jan 1, 2014, our premium will drop by $9,500 and we will be receiving Platinum level coverage. Our total out-of-pocket is capped at $2,000, with a per member deductible of $500. Our current plan has a total out-of-pocket cap of $10,000, with a $2,000 per member deductible and the premium is close to $21,000. In 2014 the sponsoring organization is lowering the premium to $16,500 but increasing our out-of-pocket max to $12,000, the deductible to $3,000, and increasing the co-pay to 15%. So the lower price is a trade off for worse coverage. Because of this poor coverage, we qualify to shop on the exchange. I have found that the premiums of comparable plans on the exchange, with lower deductibles and lower out-of-pocket caps, are priced almost 50% less. We will be leaving the sponsored plan. There is no way we want to risk paying $3,000-$12,000 out-of-pocket when we could pay $500-$2,000. Just no reasonable reason to make that choice.
Last year our premium was a bit over $20,000 because of the older, sicker pool of close-to-retirement aged, baby-boomer, male Pastor employees that we subsidized with our youth and our health. FYI for any of the 70-80% of readers who don't attend church: Most Pastors do not take very good care of themselves. They are sedentary, overweight, often suffering from depression, overworked to the point of exhaustion, in denial that 70-80% of the general population thinks churches suck, and socially isolated. With all of this crap to deal with, most of them put off dealing with health issues until it hits the crisis point. (I want to be clear here, I'm not blaming them for their sickness or a crappy life. I'm using this reality to lead into a later discussion of the logic of the ACA as wealth redistribution.)
Starting this year we will pay less and most of these Pastors will pay more because the market will dictate that there are consequences for their unhealthy choices. For these Pastors, a bad situation just got worse. For me, a bad situation just got better. This is how a market economy often works. There are winners and losers. The selfish part of me is quite happy that for the first time in fifteen years of professional work, I will have affordable care that won't require me to pay 15% of my income for anything worse than a head cold. Two examples... when I broke my arm eight years ago we paid $4,500 for the surgery and our gross adjusted income for the year was $28,000. Or seven years ago when we paid $3,500 for a C-Section. Both times, credit-card balances were carried, fun was delayed, and stress was evident. I had naively assumed that insurance meant we were covered.
I agree with anyone who thinks the ACA is about wealth redistribution but I would use the real facts from above to support my belief that the health insurance market has been a price-controlled oligopoly, run by people who structured the market to support unsustainable, unhealthy lifestyles at a disproportionate cost to the healthy. The healthy have been paying more than a fair share to support unhealthy people who are the ones who, according to free-market logic, should be paying more than the healthy. Healthy wealth is redistributed in the private market to subsidize people who are avoiding taking financial responsibility for their unhealthy life choices.
From an entirely market-centric, selfish view, until we have a single-payer, not-for-profit system, healthy people will pay more INTO the system then they get out of it in tangible goods and they will continue to subsidize a market that profits off of sickness. Healthy people will operate at a net-loss in the business of staying healthy. Obama and the Democrats (not Republicans) who passed this law have used the ACA to bring a more just balance to this redistribution of wealth from healthy people to unhealthy people. Notice I don't say that the ACA ended wealth redistribution, only that the ACA has brought some semblance of fairness and balance to a previously unfair market.
Very soon the benefactors of this redistribution will being paying closer to the real price for their choices. Their premiums and out-of-pocket costs will increase. Likewise, the insured will no longer subsidize uninsured, younger, healthy people who gamble with their future and transfer the cost of coverage into premiums when they lose the wager. Very soon they will also have to pay their own way or pay the fines.
Obama and the Democrats (not Republicans) have passed the ACA and raised for debate the belief that people's health should not be a for-profit venture. Obama and the Democrats have begun the war against the tyranny of a private market choosing who lives and who dies. Sometimes you have to water the tree of liberty with the blood of huge profit margins.
Disclaimer:
I don't ever touch the money for my insurance, it is paid directly by my employer, so the decreased premium represents a $9,500 decrease in my total benefits package. I wish this savings would represent a pay raise, but instead it will be a savings for my employer. In 2014 they will increase my cash salary by about $10,000 and I will pay the premium directly. If all goes according to plan, the premium savings will be even greater after my estimated tax-credit. So in my case, the real-world, tangible benefit from the ACA is an increased quality of coverage, possible savings through decreased out-of-pocket expenses, and $10,000 for the operating budget of my employer which is really my operating budget since I'm one of the Ministers.