Health insurance is a hot topic these days. It seems everyone woke up one day and realized they had a stake in our national health care system, which is a good thing. Sadly, figuring out the best way to deliver health care to all Americans has almost turned into a contact sport.
The logistics alone are staggering. Even so, the ACA set up a system that works in all 50 states while setting standards of coverage and setting boundaries for insurance company behavior. The latest dust up is over the minimum standards for a health care policy and "grandfathered" plans. These plans do not meet the ACA minimum standards but since they were in effect in 2010, they could continue as long as the plan doesn't make major changes. Well insurance companies being what they are, changed these plans to where they lost their grandfather status. This means people who have these plans would no longer qualify for subsidies or exemption to the fines under the ACA. Let me clarify, these plans don't even qualify as catastrophic care policies under the ACA. That should be a clue. A $54 a month health insurance policy for a 56 year old woman is going to cover next to nothing. The fact that Republicans are defending their constituents right to own a nearly worthless policy certain to drive them into bankruptcy or kill them is crazy.
About 5% of America's population get individual medical insurance policies that cost more and cover less, but neither CBS nor NBC covered that aspect of the story. About 15.8 million people out of about 317 million people had nearly no protection before the ACA and a much higher chance of being screwed over by their insurance company. Does either CBS or NBC cover the atrocity of taking money for insurance coverage that leaves you all but bare? Oh, no they go for the sensational bullcrap story line. According to NBC 40-67% and possibly up to 75% of people with individual policies will not be able to keep their insurance that doesn't insure them against much of anything. If you need numbers, anywhere from 6.3 million to 11.9 million people will need to make a change, because what they have now no longer qualifies as insurance. Yes, the ACA forces people to change from junk insurance to something that offers real security.
Up to 75%!
Until you put it in the context that we live in a country of 317 million people
75% of 5% is is 3.75%
3.75% of 317 million is about 11.9 million people.
Maybe we should flip this around.
Wow! Nearly 12 million people courted bankruptcy or death for years! and didn't know it!
Ok, here's a question. How many people have the same individual insurance policy today that they had in March of 2010? Answer, not many. Most people take individual policies until they can get something better.
A real investigative report would have looked at the bankruptcies filed last year in Florida and noted how many of them had people with junk policies like Florida Blue 91.
A real investigative report would have shown how much revenue Florida is going to lose because their bone headed state legislature won't expand Medicaid.
The current story line that Obama lied and a story about a whole lotta lyin' going on about Obamacare is far more interesting than a headline that states 2010 Projections Are Proving True. Anyone following the ACA storyline from the beginning knew about half the individual policies were toast under ACA rules. Yeah, but these people are losing their insurance! and you said, (insert wailing 8 year old here) I could keep my insurance! Except, you can't keep insurance that doesn't qualify as insurance anymore and expect to receive subsidies for it or avoid the fines because those soon to be phased out plans aren't insurance anymore.
How we get our insurance says a lot about how we see the ACA. Employers provide insurance to about 49% of our population, Medicare takes care of about 16%, Tricare covers 2.6% and Medicaid covers 13%. For around 80% of Americans, nothing will change come January. That is still true. Except maybe a Medicaid recipient could face a change if their income increases and that would be good for them...probably. Oh, and, except when your employer decides to change plans and then, well, that never was up to you in the first place. Except, maybe your employer decides they can't afford to offer insurance at all.... Except... except our nation's insurance situation isn't very secure at all and everyone except the media seemed to know that.
Most reasonable people realized Obama's promise had some disclaimers and he should have said them, but he didn't. So, Deal. About 250 million Americans this January will see seamless change, but up to 11.9 million people on the junk insurance market will be ...expensively inconvenienced. Some will find getting a real policy to be sticker shock, but that's what the subsidies are for and the new plan will be insurance they can afford to use.
What's more, that "inconvenience" could save their life. It certainly will help prevent medical care caused bankruptcies.
Consumer Reports did an extensive article on these inadequate plans back in 2009 before the ACA and listed 7 warning signs of what would indicate a junk insurance policy. Analyses like this paved the way for the ACA.
Do everything in your power to avoid plans with the following features:The ACA eliminates the above 7 point check list. Limited benefits are gone. There are 10 essential benefits every plan has to provide: "ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including dental and vision care," according to Healthcare.gov. There will be no more caps on coverage or caps on care you will use like the ER, hospital in-patient care a diagnostic MRI. There will be a cap on your out of pocket costs. You can probably keep your doctor, but you can't keep your stingy, bare bones limited liability plan.
Limited benefits. Never buy a product that is labeled “limited benefit” or “not major medical” insurance. In most states those phrases might be your only clue to an inadequate policy.
Low overall coverage limits. Health care is more costly than you might imagine if you’ve never experienced a serious illness. The cost of cancer or a heart attack can easily hit six figures. Policies with coverage limits of $25,000 or even $100,000 are not adequate.
“Affordable” premiums.There’s no free lunch when it comes to insurance. To lower premiums, insurers trim benefits and do what they can to avoid insuring less healthy people. So if your insurance was a bargain, chances are good it doesn’t cover very much. To check how much a comprehensive plan would cost you, go to ehealthinsurance.com, enter your location, gender, and age as prompted, and look for the most costly of the plans that pop up. It is probably the most comprehensive.
No coverage for important things. If you don’t see a medical service specifically mentioned in the policy, assume it’s not covered. We reviewed policies that didn’t cover prescription drugs or outpatient chemotherapy but didn’t say so anywhere in the policy document—not even in the section labeled “What is not covered.”
Ceilings on categories of care. A $900-a-day maximum benefit for hospital expenses will hardly make a dent in a $45,000 bill for heart bypass surgery. If you have to accept limits on some services, be sure your plan covers hospital and outpatient medical treatment, doctor visits, drugs, and diagnostic and imaging tests without a dollar limit. Limits on mental-health costs, rehabilitation, and durable medical equipment should be the most generous you can afford.
Limitless out-of-pocket costs. Avoid policies that fail to specify a maximum amount that you’ll have to pay before the insurer will begin covering 100 percent of expenses. And be alert for loopholes. Some policies, for instance, don’t count co-payments for doctor visits or prescription drugs toward the maximum. That can be a catastrophe for seriously ill people who rack up dozens of doctor’s appointments and prescriptions a year.
Random gotchas. The AARP policy that the Clausens bought began covering hospital care on the second day. That seems benign enough, except that the first day is almost always the most expensive, because it usually includes charges for surgery and emergency room diagnostic tests and treatments.
Let's dive into that CBS story of the Florida woman forced out of her $54 per month health "insurance" policy. Florida Blue has a Consumer Directed series of plans where the policy is cheap, but the coverage is hit and miss...mostly miss. They also have a medical discount program that won't offer much help for cardiac catheterization (should you need it). The soon to be defunct GoBlue 91 pays a maximum of $50 per date of service per provider for covered services only (and those services are very limited), $0 for hospitalization (unless you are experiencing complications due to pregnancy and then it will pay $50), it pays a $15 discount on prescriptions. That's junkier than most junk insurance. Credit goes to Greta Susteren, of all people, for almost calling out how bad this $54 per month policy is, Susteren called it "bare bones". I call it faux insurance. Susteren also got Dianne Barrette to admit she qualifies for a fair amount of subsidy and has 10 other plans to choose from and her subsidized premium falls to about $209 per month for real insurance. Not the fake stuff, the real deal.
10:36 AM PT: I just read this from my Huffpo link in the diary:
Still, we are left with Obama's phrase,
"If you like your plan, you can keep it,"
that probably should have come with a bit of fine-print reading,
"Some restrictions apply, void where prohibited."