ACA & Me

May 30, 2017

     Healthcare, specifically government involvement in healthcare, is both a unifying and

divisive issue in America. Before Medicare was established in 1965, government healthcare goes back to caring for military veterans of the Revolutionary War and mandatory smallpox vaccinations by individual states.  

     With all this history of our government providing, legislating, and mandating healthcare, why is the United States the only one of thirty-three ‘developed nations’ without some form of universal health care available to every citizen without regard to income, social status, race, religion, sexual orientation, and the rest of our favorite designations? More specifically, the USA is the only country in the Organization for Economic Cooperation and Development (which doesn’t include China or Russia) not providing universal healthcare. Framing the question about government sponsored or legislated healthcare is as important as the answers.

The following interviews represent a cross section of people I know who shared their experiences with the ACA.

Mel Myers is probably the healthiest sixty-three old man to whom I’ve spoken. He has almost never been sick or hospitalized. Like many American’s, Mel has been through layoffs and continued his healthcare plan through *COBRA.

     When those benefits expired, Mel became self-insured purchasing a healthcare plan through Blue Cross Blue Shield (BCBS) with a high deductible costing around $200 monthly before the ACA was enacted. The first year the ACA was in effect, his BCBS premium went from around $200 to $299 just before the ACA took effect. In Mel’s mind, the insurance companies saw Obamacare coming and unnecessarily jacked up prices in advance, so their high prices under the ACA wouldn’t look so bad in comparison.

     Mel commented, “Just an opinion, but being perfectly healthy and having made no claims, there was no reason for them to raise my bill at that time. The first year of the ACA, Coventry One out of Kansas was my insurer at $367.64 per month. After the first year, Coventry One pulled out of the Oklahoma exchange completely, and I was back with BCBS, which has raised prices every year, up to $932 per month for 2017.”

     Being self-employed, Mel commented, “The Affordable Care Act should be called the Care Act because there’s nothing affordable about it. In fact, the way it’s structured encourages staying poor because having less income qualifies people for subsidies.”

     For the first time in years, Mel is now uninsured and in favor of the ACA being repealed. Having more insurers offering coverage would lead to increased competition and lower rates.

 

Ian Watteau (pictured below with his family) is a registered nurse and physical therapist assistant licensed in Oklahoma who works as needed for Brookdale Home Health and full-time for a local hospital. He is also married with three young children.

     You would think working for health care providers, Ian and his family would be covered through an employer sponsored program. In fact, he opened my eyes to another way of obtaining healthcare services through Liberty HealthShare at a cost of $460 monthly with a $1500 deductible for his family.

     Information on the website describes Liberty as a community of health-conscious Americans who practice longstanding Christian principles in sharing healthcare costs. It is not insurance. It simply unites like-minded Americans to share medical costs together. Find complete information at libertyhealthshare.org.
 

     He also participates in a plan through a local physician for his children costing $85 monthly covering office visits and other services.

     As an insider working for healthcare providers Ian said, “The ACA has demoralized hospitals. Hospitals are rated on a scale of one to five stars with five being the highest  rating. With the exception of one hospital, those in Tulsa area are rated at three of five stars.”  

     The ratings are based on patient surveys and nine out of ten people express some level of dissatisfaction. In his opinion, “This turns hospitals into hotels where managing pain is the most important amenity. Patient dissatisfaction lowers ratings resulting in less compensation for employees and higher nurse to patient ratios. Managing pain is significant, but patients also need to be educated about pain management.” According to Ian, at least one local hospital created a staff position to work on improving ratings.

     Smaller healthcare providers, like home health agencies, are also subject to ratings as a result of the ACA, requiring more paperwork and documentation. Ian said, “Rac Auditors, referred to by healthcare workers as bounty hunters, will come to a small provider and pull three or four charts to rate everything. A bad rating can result in fines, etc. and put smaller providers like mom and pop home health agencies out of business.”

     He continued, “For instance, under Medicare, a patient may be assigned up to twelve visits from a home health agency that is paid in advance for the service. A bad rating based on a small sampling will result in Medicare requiring a refund of part or all of the advance payment. The process isn’t logic based and it is nickel and diming large and small institutions.”

 

 

Michele Chiappetta (link to blog in photo) is employed full time as an editor, content writer and does fundraising for a local nonprofit. She is covered by healthcare partially paid for by the employer through Community Care. Under the ACA, the organization sought and was granted an exemption on covering birth control for female employees. However, Michele 
received a letter from Community Care explaining how she can receive birth control separate from the employer paid coverage. It’s one of the real-life exceptions insurance carriers provide to accommodate needs of women covered under their plans.

     Uncertainty over the ACA and the future of healthcare represents a different challenge to Michele who is considering starting her own business. “As an  entrepreneur, I understand I’ll be responsible for paying the cost of my healthcare. I’m considering using COBRA, depending on the cost, but the long-term uncertainty  over the cost of healthcare is a big consideration.”

     She continued, “I have often thought, what if I’d made the decision to start my own business in the last year or two. Where would I be now with the limbo created by  potential changes or elimination of the ACA? The  unpredictability and lack of information delayed my decision.”

My story. When the ACA took effect, I looked into  the cost of health insurance through the exchange. Like  Mel Myers, Coventry One out of Kansas was my initial insurer at cost close to $400 per month. I didn’t qualify for a subsidy in 2015, although my income wasn’t all that high. Move forward to the beginning 2016, BCBS was the only insurer remaining in the exchange at a much higher cost so I went uninsured.

     When the enrollment period opened for 2017, I had begun drawing social security so my projected income for the year is based on it, qualifying me for a subsidy tax credit reducing my monthly premium for BCBS coverage to $3.19. Unlike Jane A., I have no problem taking advantage of the subsidy. I also understand that under the current rules, if my actual income for 2017 exceeds the projected income the $3.19 premium is based on, I will be required to repay several hundred dollars in tax credit used to subsidize my premiums. Mel Myers observation is correct. The way it’s structured encourages staying poor because having less income qualifies people for subsidies.

     My observations and final words - Will the United States ever adopt ‘single payer’ or ‘socialized medicine’ to cover all citizens? Is healthcare a right or a responsibility of every individual to provide for themselves? I don’t have the answers but I will offer some observations.

     Our current president recently stated, “Nobody knew healthcare could be so complicated.” He’s right, but as these interviews demonstrate, rising cost and uncertainty about government involvement are the major difficulties facing these folks.

     Would single payer, socialized medicine improve healthcare access and outcomes in our country? Like any major change, there would be problems because someone will always come up with ways to ‘game the system’ to their advantage or to the disadvantage of others just like they do now.

     Does our current system of availability and access to healthcare need to be changed and improved? The answer to this question usually results in a unanimous and resounding chorus of YES IT DOES, but the solutions to make it happen are driven by political ideology and have put us where we are today. Here’s the thing, with the exception of Medicare, one way or another, healthcare in our country is largely provided by ‘for profit’ insurance and pharmaceutical companies. Lobbyists, individuals, PACS and corporations heavily contribute to political campaigns and political parties, some in the form of ‘dark money’ thanks to Citizens United. We’re all for free speech but are the reforms people are seeking even possible under the current system?

     Based on what we’ve seen since implementation of the ACA, changing, repealing, or replacing the current system isn’t happening. As citizens, our only recourse is to work within the political system to make change by becoming an active part of the process. Borrowing and slightly editing something I’ve seen in speeches and heard on TV and in movies, “Decisions (and therefore changes) are made by those who show up.” 

     It’s your healthcare. Are you going to ‘show up’ to see it changed, repealed, or replaced? One thing is certain, the insurance and pharmaceutical companies have shown up and will continue to do so. If individual citizens don’t show up, we’re likely to see more of the same.      

     *COBRA - (from Wikipedia) The Consolidated Omnibus Budget Reconciliation Act of 1985 (or COBRA) is a law passed by the U.S. Congress on a reconciliation basis and signed by President Ronald Reagan that, among other things, mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment.

 

 

 

 


 

 

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