This message is for the administration, specifically for the folks at Health and Human Services. They said they were not going to tolerate abuses in the health care market places. They said that insurance plans that offered too few providers and which limited drug coverage or which had outrageous obstacles to care would be hearing from Washington.
Well, Department of HHS, we need you right here in Tarrant County, Texas, right now. No, I am not talking about the poor working class folks who do not make enough money to qualify for a federal subsidy. They will continue to qualify for their county funded public health program.
I am talking about the lower middle income workers who make just enough to qualify for a federal subsidy but who live from paycheck to paycheck without an extra $100 to $200 a month to pitch in to supplement the federal government's portion. I am talking about those folks who can afford only one "Affordable Care Act" option, the one they call HMO.
If you are less than 20, you do not remember HMOs, Health Maintenance Organizations. You are lucky. HMOs went the way of the dinosaur for a very good reason. Patients and doctors hated them, because they restricted patients' access to care. But, now that health insurance plans have to accept everyone, even people with pre-existing conditions, they are back. The principle behind them is simple. They are a great deal for young people who never get sick and just need back up insurance in case they get run over by a truck. They are worthless for people who actually need their insurance.
The HMO that lower-middle income workers in Tarrant County have been offered is a particularly nasty one. What I am writing is hearsay, but I have heard the same thing repeated often enough from enough sources to believe that it is probably true. There are three---count them THREE---primary care providers (pcps) in the county that accept HMO. And in order to see a specialist on an HMO and get the HMO to pay for it, you have to see a PCP first. Good luck with that if there are only three of them. And two million people live in this county.
The second problem with HMO--the huge deductible. I have heard figures that range from $5000 to $12000 a year. I have heard the $5000 more often so I suspect that is the single member deductible and the $12000 is the family deductible. Correct me if I am wrong, but was not that one of the things that the ACA was supposed to fix?
HMO will be collecting federal premiums and paying out nothing since its lower-middle class enrollees will not be able to get appointments with its three pcps or meet their huge deductibles. HMO is making windfall profits. If even half of what I am hearing is true, someone in the federal government needs to get down here and check out HMO before they start cashing federal government checks.
True or not, these stories have a lot of people very worried---people with serious health conditions who do not need to add worry to their already loaded plates.