Posted on 12/24/2014 12:37:12 PM PST by Kaslin
The argument for Obamacare really boils down to one idea: people without health insurance won’t get medical care. Or if they do get it, the care will be too little and too late. Insure everybody, we were told, and everyone will have access to high quality, timely care.
But is that really happening? It may not be.
Unless they were previously uninsured, people who are getting health insurance in the (Obamacare) exchanges are likely facing greater financial barriers to care than they were before the health reform was enacted.
According to a study by Avalere, the average out-of-pocket maximum for 2015 individual silver plans will be $5,853. This is about twice the level in a typical employer plan and none of the exchange plans have an employer making deposits to a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA).
Even though more people are insured today than in quite some time more people are putting off medical treatment because of cost than has been the case in the past eight years!
One of the goals of Obamacare was to end discrimination against people with (pre-existing) chronic conditions. Today, insurers can’t deny them enrollment, but they can shift a lot of the cost of care to the sickest patients, including the cost of their medications. According to one report:
Actuarial studies of plans sold through health insurance marketplaces in some states found that many make consumers responsible for as much as 50 percent of the price of specialty drugs, which can cost $8,000 or more a month.
These aren’t isolated cases. Even the Obama administration has become alarmed.
In addition to financial barriers to care, there are non-financial ones – mainly caused by the narrow networks that have emerged in the insurance company race to the bottom. These networks often exclude the best doctors and the best hospitals. A study by Avalere found that there were no cardiologists in the networks of plans offered in Los Angeles. There were no diagnostic radiologists in the networks of plans offered in Chicago. In seven of the nine urban areas, fewer than half of specialists sampled belonged to provider networks in Obamacare exchanges. Patients can be forced to pay 100 percent of the cost of out-of-network services.
About half the newly insured will get insurance through Medicaid, where there is little or no cost sharing. But here again, there are serious non-financial barriers to care. According to a study by the inspector general of the Department of Health and Human Services about half the doctors who are listed by insurers as serving Medicaid patients are not available to treat them. Those who are available often require long waits:
“For example,” the report said, “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”
Primary care providers, such as family doctors, internists and gynecologists, were less likely to offer appointments than specialists, the report said. But specialists tended to have longer wait times, with a median wait of 20 days, compared with 10 days for a primary care provider.
These problems will almost certainly get worse in January when an end comes to a special Obamacare subsidy that has been enhancing the fees of Medicaid doctors for the last two years. According the Washington Post:
A study … from the nonpartisan Urban Institute estimated fee reductions will average about 40 percent nationwide. But they could reach 50 percent or more for primary care doctors in California, New York, New Jersey, and Illinois — big states that have all expanded Medicaid under the health law.
A system-wide problem will add to these woes. If the economic studies are correct, the newly insured will try to consume twice as much health care once they have insurance and there may eventually be 25 million of them. Along the way almost everyone else is being forced to have more generous insurance than they previously had and with these new benefits they are likely to seek more care. The result: we are in the process of greatly expanding the demand for care while doing virtually nothing about supply.
A final (and largely overlooked) problem is that the safety net is being decimated. Obamacare is reducing “uncompensated care” funds to safety hospitals at a time when their case load is increasing and states actually have perverse incentives to dump large portions of their Medicaid populations. To add insult to injury, private donations are down for free medical clinics around the country and many are closing their doors.
Bottom line: We have spent an enormous amount of money on health reform. It is not yet clear whether there has been an overall increase in access to care – especially by the most vulnerable patients.
As it is often said: You haven’t seen anything yet.
Many “thanks” to the LIBs/DIMs/RINOs(who got it through committee).
Have a Merry Christmas!
Did the Pope used to be Catholic?
Two outcomes - limitations on what services will even be covered, and once a certain predetermined level of medical services have been delivered, further service shall be denied.
By the time you reach the age of 75 or so, you are pretty much on your own, as NO extraordinary measures will be permitted for life extension. Something about “Quality of Remaining Years”, a younger person may benefit for many years longer than a person already in their eightie’s.
We have to look at the bright side.
Those 15,000 attorneys and accountants the IRS hired to administer the program are having a wonderful Christmas.
Obama LIED, people died.
Our governor here in Texas may not be on anyone’s short list for a Nobel Prize, but he DEFINITELY got it right with the Medicaid Expansion.
The bait was that the feds would “pay” for the expansion, nearly all of it. The governor correctly knew this was too good to be true, and unlike most Republican governors, wanted nothing to do with it.
And now we see the results of expanded Medicaid - LOTS MORE OFFICE VISITS, but the reimbursement rate is so low, that doctors don’t even break even on these visits - so good luck getting a doctor...as we’re seeing in those states, but not in Texas, thankfully.
More people in the doctor’s office and longer waits means health care is rationed and the quality of care of paying paying patients is degraded.
I want a conservative congress to pass a law.
“The American Freedom and Liberty Act”
The law would state that any citizen of the United States who chose to do so, could elect to NOT participate in any federal program oriented to individuals, the sole exception being an actual enumeration (only) of them as a person for the purposes of the US census.
This means that with a single declaration, an individual could remove themselves permanently from the Social Security System, Medicare, any form of welfare or food stamps, any federal databases other than criminal, no housing assistance, no food assistance, no educational assistance, no medical (Obamacare) enrollment, or any other program directed at individual citizens and others.
The greatest part of the bill would be that they would no longer pay any Federal Insurance Contributions Act (FICA) tax, nor any Obamacare tax, or any other tax made as an individual payment on the promise of a federal benefit return.
Importantly, they would also not be subject to any punishment for having done so. That is, no “alternative to FICA” tax, no requirement for paperwork or identification, no denial of any publicly offered benefit. And as part of this, the states could not be compelled to force citizens to participate, either, nor could they do so voluntarily.
I looked into the insurance cost for just me on a bronze plan. It is $8,000 per year, no medicines or office visits. I have to spend an additional $10,000 before any “benefits” kick in. I figure for $18,000 I can visit a doctor a few times at $250 per and still be money ahead. If something serious but longer term hits, I’m off to Puerto Rico or India for treatment.
It won’t be long before Americans are as familiar as Canadians with the term “waitlisted”.
Your costs look unusually high.
Did you factor in potential tax credits?
Those are issued depending on your income. They are very generous if you are below $35K or have a lot of dependents.
I tried to get exact numbers for you from the Washington State Health Exchange, but the site is down for late night maintenance (it’s actually one of the best run state websites in the country).
Is Obamacare essentially crap-care?
Yes.
Where else is the money for derivatives and the Insurance (Investors) Lobby Gang going to come from? Certainly not for the primary purpose of health care.
If you’re thinking about going overseas for an operation, Thailand has some top shelf hospitals. I had shoulder surgery at Bumroongrad Hospital in Bangkok a few years ago, and it puts a lot of hospitals in the US to shame. I was working in Iraq at the time, but scheduled online for 3 appointments within 3 hours of my landing in Bangkok. Had an MRI on my shoulder that night and surgery the next day.
“Did you factor in potential tax credits?”
My state did not set up its own exchange. Therefore there won’t be tax credits. Also, I have zero income, but do have 401k’s. I don’t know how they would factor in, but I do know you can’t take any agencies’ word on that. The IRS tells you that they aren’t responsible for giving you wrong or misleading advice.
Frankly, I’m hoping to wait until Obamacare has been done away with and then I’ll get a catastrophic care policy, which is currently illegal.
False premise.
No one believes that, and no one ever did.
I think they are universally available and based on “income” only.
When you say “zero income” if that means “zero income from employment,” O-Care actually does count investment income and retirement income, like a pension or 401k, as “income.”
But, if you are currently living off just personal savings (at a very low interest rate) or home equity, then your “income” is essentially zero, and, most likely you would qualify for substantial tax credits.
Did your state accept or reject the new ObamaCare version of Medicaid?
If your state accepted the “new” Medicaid, a single person (no dependents) is eligible for that if his income is below about $15,500.
Medicaid has no premiums and no out-of-pocket expenses at all.
But, one important thing about Medicaid in some states - if you have assets like a home or investments you plan to bequeath to family or friends when you die, Medicaid might be able to make a claim against your estate for the insurance premiums and costs they paid on your behalf.
The current lawsuit before the Supremes is about the tax credits being, by law, only available to those states that created their own exchange. If the Supremes decided as the law was written, then any credits given will be owed back with interest.
As for Medicaid, you are correct, they will take it out of my assets. What I’ve discovered is they seem to be taking everything they can get, and appear to be evaluating the services at premium prices.
It is my hope that this law goes away and I can again buy catastrophic care insurance, which is all that I need.
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