Posted on 04/14/2017 10:07:39 AM PDT by SeekAndFind
As Republicans’ effort to resuscitate their plan to “repeal and replace” Obamacare gains momentum, perhaps it would be illuminating to ask someone who is actually insured under Obamacare to share his or her perspective.
My wife and I are both older than 60. We are in excellent health, not under any prescription drug regimen, and physically active. We live in New Hampshire, which enjoys not only a variety of weather patterns, but a plurality of Obamacare insurance providers.
My wife and I have not benefitted from an employer-provided health insurance plan for more than three years. We have instead obtained our health insurance through Obamacare. To keep the insurance plan, doctors, and hospitals we liked for more than 14 years, our premiums under Obamacare increased 225 percent with deductibles increasing 325 percent.
We couldn’t afford the annual premiums of $22,000, so we were forced to change our doctors and insurance plan. While we managed to reduce our premiums, we lost significant choice in hospitals and were subjected to ever-increasing deductibles.
We purchased our Obamacare through a broker because doctors convenient to our location who were accepting new patients only accepted broker-sourced insurance plans. Had we purchased our Obamacare via the “exchange,” our nearest doctor would have been more than 45 miles away, more than an hour’s drive. The exchange-sourced policies also featured extremely limited hospital availability.
While relatively healthy, we recently needed treatment from our physician. The treatment was minor, but it laid bare the realities of what is covered by one’s plan and out of one’s deductible. Thankfully, a helpful customer service person from our insurance company explained how Obamacare coverage really works relative to essential health benefits.
The key distinction is the difference between preventative and diagnostic procedures. Preventative procedures are covered directly by one’s Obamacare policy, and not subject to deductibles. Under our policy these are limited to mammograms, colonoscopies, appointments for gynecological exams and physicals, and cholesterol screening. Diagnostic procedures include all other procedures and tests and must be paid for by the patient until his deductible limit has been satisfied.
Given the focus on prevention to head off serious medical issues, including these procedures and tests is appropriate. However, if we were to avail ourselves of all these tests during a normal year, the imputed cost would be less than $2,000 for both of us. This includes the prorated cost of a colonoscopy, since we, thankfully, don’t need to experience that procedure every year.
After accounting for these annual preventative treatment costs, there is more than $13,000 remaining of our more than $15,000 annual premiums to cover a serious or catastrophic situation. However, the coverage associated with that remaining $13,000 is not available until we have paid approximately $15,000 in deductibles (i.e., roughly $7,500 per person). The impact of deductibles is particularly vexing if one becomes sick at the end of a given policy year, as the deductible balance resets to zero on January 1.
We are thankful that we are healthy and take deliberate steps to remain so. However, with the only thing guaranteed in life being yesterday, we have to set aside financial resources in case of a worst-case scenario. For us that means setting aside more than $30,000 in after-tax dollars to cover our premiums and deductibles.
In real terms, we need to earn at least $42,000 annually to cover just our potential medical cost exposure. Over the past three years, the nearly $50,000 we have paid in premiums alone represents over six months of living expenses after the effective costs of covered preventative procedures are netted out. Our efforts to live a healthy lifestyle have allowed us to spend nearly $50,000 for risk coverage we have, thankfully, not needed.
How much did the Obamacare mandates for pediatric dental, prenatal care, and other issues that a married couple over 60 has little or no use for exacerbate our significant financial burden for premiums and deductibles? It is hard to really know. What we do know is that our total annual exposure for medical insurance is more than our mortgage payments.
So, how are we impacted by Republicans’ alternative to Obamacare, the American Healthcare Act (AHCA)? It is difficult to quantify because all that has been loosely shared may only be act one of a three-act drama. However, if what we have glimpsed of the Republicans’ dress rehearsal goes into production, we can extrapolate some repercussions.
The AHCA provision to allow insurers the latitude to charge older people five times more than younger people is worse than Obamacare’s factor of three. While the AHCA eliminates the Obamacare individual mandate and IRS penalty, it imposes a penalty of up to 30 percent of one’s premium for 12 months for not maintaining continuous coverage. Obamacare’s income-based subsidies are replaced by the ACHA’s age-based tax credits, which further penalize older individuals. Please note that the Obamacare subsidies are only available for those who purchase their policy via an “exchange”: broker-sourced coverage is not eligible for any subsidy.
For this healthy couple over 60 years old, there is no substantive difference between Obamacare and the AHCA. In many respects, we may be worse off financially. Until we can purchase medical insurance more tailored to our specific needs and considerations, we are up a proverbial creek without a paddle or even a canoe. Moreover, we are extremely concerned that the extreme dysfunction over insurance will only accelerate the disturbing erosion in the quality of our health-care system.
Repeal it.
Remove regulations which limit what people can buy.
Let the marketplace solve it.
Yes, some rich guy is going end up with better insurance than me. So, what else is new? It’s the way of the world.
Repeal it. Go back to free markets.
The GOP (who invented and imposed RomneyCARE/ObamaCARE)
LOVES socialized medicine controlled through taxes
as long as they, and their families, and their staff,
and their staffs’ families .... are EXEMPT.
and so it is.
YEAH BUT you would need $44,500 if it wasn’t for Obamacare. I’m lovin’ that extra $2500 cash money in my wallet from the glorious Obamacare savings.
There's a simple reason for this: it is not the government's function to be involved in health insurance at all, saving for the prosecution of fraud, larceny, robbery, manslaughter.
There will be no repeal.
The Uniparty eunuchs serve as attendants of Fedzilla, which derives great power from controlling all health care decisions and medical records.
They will never vote to remove that power from Fedzilla.
Repeal and replace is a euphemism for rearrange and repair.
Repeal:1.revoke or annul (a law or congressional act):
This they will never do.
Repeal and replace is a euphemism for rearrange and repair.
Repeal:1.revoke or annul (a law or congressional act):
This they will never do.
Health care, or its insurance is not a right.
How can it be if we are to be penalized for not buying it from the government? It is financially based so can not/will never be equal for all.
ObamaCare was broken in its inception, as we would see it, but as the specter that allowed the govt to push regulatory control over such a large amount of its citizens and economy it has done exactly what it was designed to do.
It may be helpful to break this into 3 pieces:
1. Health care - this is simple because it literally means meeting your health care needs. In the US everyone has access to basic life preserving health care. How it is delivered andpaid or not paid for is a donneybrook.
2. Health care insurance - a way of paying for health care and insure against cost that you cannot financially bear.
3. Government spending on or directly providing health care
4. Government regulation of health care.
Seems to me we can have a free market for 1and 2 and we can allow 3 and 4. Completely and utterly deregulate 1 and 2. Make 3 and 4 an option. We can debate what 3 and 4 should be and how much we wished to be taxed. 1 and 2 require no debate other than deregulate and leave alone.
4 out of 3 Americans have a hard time with math. In first on my own mistake.
Good article. I have an uncle who retired early (58) but likes to work part time to keep busy. With his investment income and part time work he was ineligible for any subsidies. He now has to pay over $700 a month just for premiums. He has no pre-existing conditions and only goes to the doctor for an annual check up.
Well, this does leave us in a bit of a quandary. The Freedom caucus is for Repeal
The Donald is dumping on the members of the Freedom Caucus
What Deal are we going to get - A RAW Deal, or will the Donald DEAL with the Rinos?
There is no legitimate federal constitutional authority in health care. Us “purists” aka real Americans understand that. Realistically it won’t be returned to this in the short term. But that doesn’t mean we can’t have a good education/civics campaign to improve understanding, and at the same time take reasonable steps in the direction of the free market. Ryanocare is a move in the wrong direction and only serves to tar the Republican brand and free market solutions
Tell him not to buy it anymore, they arent enforcing the penalty.
Christian Healthshare plans that are government acceptd for insurance are far cheaper. Or dont have any and sock away some money each month for expenses he will have.
I am getting to be against the repugnintcans. Listened to a commercial this morning thanking my Congressman for saving the 20 million depending on Obamacare. - paid for by some hospital association. Yeah, all the illegals, all the people on welfare all the people that can walk in and pay not a thing, 20 million or more, bless their thieving hearts. I walk into an emergency room and it’s 1300 to sit down and wait. And the kicker, they want it up front now.
F em all.
Agreed on Ryancare. But I support it for Trump’s sake. We need to 100% focus on the SC and immigration and Islamization in that order.
Thanks I will have him look into Christian Healthshare.
Repeal the unlawful piece of DC takeover!
Repeal:
1 to rescind or annul by authoritative act; especially
to revoke or abrogate by legislative enactment
2 abandon, renounce
3 obsolete
to summon to return
recall
Only a politician could make it mean anything resembling what GOP is trying to do.
Duhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.