Our ongoing health care saga and the Affordable Care Act

One of the unintentional running themes in my blog has ended up being health care.

Upon our return to the USA, our primary concern was what we would do about health care. Costs in the USA are out of control, and the cost for health insurance was outrageous. How does one put a dollar value on quality of life?

When John needed an emergency appendectomy, our decision was sorely tested.

In the end, we made the decision that having the opportunities for robotics and advanced math/science studies that we have in Boise made it worth dedicating 19% of our monthly income to health insurance. We also knew that even with the health insurance, medical costs would be too much for us to afford.

We crossed our fingers and toes, hoping beyond hope that we would not need medical care until we could get back to Mexico or some other country with affordable treatment options.

Now, the situation here in America has changed. In some ways, it’s a change for the better. In other ways, it’s a change for worse. It is, nevertheless, a change. For my readers from other countries who perhaps don’t understand it all, here is my account of how the Affordable Care Act (Obamacare) has affected us.

What does the Affordable Care Act do?

ACAThe health care situation in the United States of America was broken before. Seriously broken. The ACA attempted to fix some of the worst parts of our system.

1)      Children are now allowed to stay on their parents’ plan until they are 26. Previously, kids would have been kicked off prior to that, leaving many with no health insurance at all.

2)      Anybody with a pre-existing condition would be routinely denied coverage. Health insurance companies only wanted to cover healthy people who didn’t need care. If you were one of many millions with some sort of medical issue, insurance could (and did) boot you out. Now, the ACA has prevented that from happening.

3)      There is now no lifetime max, meaning that you can continue to have insurance even if you have a condition that costs a lot. It used to be commonplace that people with serious illnesses would get treatment up to their max, then have no choice but to drop out of the treatment and die.

4)      “Health insurance” has now been defined. Whereas before, you could pick up a plan that basically covered nothing, now there are set guidelines for what a health insurance plan must cover.

5)      The maximum out-of-pocket expenses per year for a family is now $12,700. Previously, it wasn’t unheard of at all that people were paying $50,000 or more, depending on what happened with your family that year. One serious accident or illness could easily have led to a family losing their house and entire life savings.

6)      Preventative care is now provided free of charge with every insurance plan. Too often, people didn’t get routine care due to the expense, which actually meant it was more expensive when the condition reached more advanced stages.

7)      Health insurance companies are now required to spend a certain percentage of premiums on health care. That seems pretty obvious, but for years the companies have charged higher and higher rates, and pocketed the profit. Now, their profit level is stipulated by law. If they overcharge, they must issue refunds.

8)      There are now subsidies available for people with low incomes in order to help them pay for the insurance premiums.

 

How the ACA affects us

So what does this mean for us? It means that we will be getting a much better plan for a much cheaper price. Although we do qualify for a small subsidy, even without it, better plans were priced about the same as our old plan.

For the first time since we arrived in the USA and decided to be self-employed, we will be able to go to a doctor without budgeting for it for months. Now, we won’t have to fly to another country if we need surgery done. And we’ll have the confidence of knowing that if we do need treatment, we won’t lose our entire life savings to pay for it. That’s huge.

How the ACA affects others

Unfortunately, some people are seeing their rates increase. I’m hearing from some people that their premiums are as much as doubling. I’ve heard from others that they have no choice but to go without health insurance now.

It seems to me that what we’ve done is manage to insure the poor, while at the same time, un-insure some of the middle class. We’ve traded one group for another. Which group has the greater number of people? I don’t know. I hope that when all the dust is settled, we will have more people covered with health insurance than we had before.

But what about health care costs?

What the ACA didn’t do is regulate health care costs at all. Although I suspect the reforms will affect costs somewhat, we still need to take some pretty serious measures to bring costs down. Yes, people are now insured, and that’s a good thing, but the costs are still entirely too high.

Why no public option? What about universal single-payer health care?

My theory on this is that the American people simply were not ready to move to a universal system. They were too tied to the idea of private health insurance companies and going from where we were to universal coverage was a leap way too big. I’ve had a few people try to explain why they were against it, but so far I’ve never heard a logical argument against.

The propaganda is deep here in the USA these days. Opponents of the ACA talk about death panels and government mandates of certain procedures. They claim Obamacare is killing jobs and that socialized medicine equals communism. Mostly what they say is flat-out false, yet there are many who believe it.

I was discussing the idea of living your dream with some friends the other day. For every single American in the group, our major concern was getting sick and not having enough money to pay for treatment. Even with health insurance, we’re concerned about the financial side of health care and that affects what we’re willing to do in terms of living our lives the way we want. We Americans all had back-up plans to go live in another country if the worst happened.

For my Canadian and British friends, however, they had the comfort of knowing that if something major happened, all they had to do was get back home and they would be taken care of. They didn’t have to worry about saving many thousands of dollars for a medical emergency. They didn’t have to think of a back-up plan of living in some other country if they get really ill.

To me, that speaks pretty dramatically about our health care problems in America.

The Affordable Care Act has attempted to fix some of the problems, but we still have a long way to go.

 

books by Nancy Sathre-Vogel

About Nancy Sathre-Vogel

After 21 years as a classroom teacher, Nancy Sathre-Vogel finally woke up and realized that life was too short to spend it all with other people's kids. She and her husband quit their jobs and, together with their twin sons, climbed aboard bicycles to see the world. They enjoyed four years cycling as a family - three of them riding from Alaska to Argentina and one exploring the USA and Mexico. Now they are back in Idaho, putting down roots, enjoying life at home, and living a different type of adventure. It's a fairly sure bet that you'll find her either writing on her computer or creating fantastical pieces with the beads she's collected all over the world.

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10 Responses to Our ongoing health care saga and the Affordable Care Act

  1. Rilla December 18, 2013 at 11:56 am #

    Thanks for doing this overview of the ACA. It answered a lot of questions for me… I think it’s a HUGE step in the right direction, and hope that universal healthcare happens sooner than later. It’s interesting that the ones that are opposing it are likely the ones that are benefiting the least without it…

    As a comparison, I am Canadian, born and raised. We work hard and make a decent living, I would call us lower middle class. We own a small home, have owned a successful small business for the past 5 years, are well educated, and drive a newer vehicle that was gifted to me from family. On the other hand, we are paying off large student loans and have three maxed our credit cards (around $18k). We live frugally, but anytime there’s an “emergency” we don’t have any cushion and end up relying on credit cards to get through it. We are slowly working our way towards being debt free, but it’s a process…

    Our income is high enough that we do not qualify for any interest relief on my student loans or health care subsidy and our family of three pays $135/month for government health care. There’s ZERO out of pocket costs for medical care, and we pay 100% OOP for prescriptions, eye care, and dental. Our total annual cost including monthly health care and OOP averages out to around $4000 a year, around $350/month for our family. As you can see, universal health care is NOT free. In addition, we pay another $300 for life insurance, disability and critical care insurance (because we are self employed). We also pay taxes to support the system. All this fear mongering about the country bankrupting because people are getting a free ride makes no sense to me… Of COURSE you pay for it… When I was a struggling single mom for a couple years I went without dental, and the government subsidies covered prescriptions and eye care. Now that we are financially independent, we are helping support families who are in need… It feels like a contribution to the well being of my fellow man, not communism (which I’m sure you know has never been actually been accomplished, even in countries that claim to be communist). LOL

    In contrast, I lived in the states for four years. For a couple years I worked for United Healthcare and had a decent health insurance plan through my job. I still had to pay a LOT of OOP, I was limited to our network, which didn’t always have the care I required for my family, and we only ever went to the doctor for illness, not preventative care. When I wasn’t employed we lived on a song and a prayer, literally. If we got sick we suffered through it cause there wasn’t money for doctors. That’s no way to raise a family. I’ll take my current situation over the American’s private insurance options any day…

    The only “constructive criticism” I have is that I’d like to see links to where you got your info about the details of the act. I’d like to pass this on to some American friends who have bought in to the fear mongering propaganda around the ACA, but I am certain they will discount it without links to back up your claims.

    [Reply]

    Nancy Sathre-Vogel Reply:

    @Rilla, Thanks Rilla. I always find it interesting to hear from people who do have universal coverage – they always seem to be baffled that there are Americans that are opposed to it. As for where I got my info, here is the brochure from my company – the overview of changes is listed on page 5 – https://www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf

    [Reply]

  2. Greg Ramos December 18, 2013 at 12:59 pm #

    Thank you Nancy for this great information. Yes ACA made some changes indeed. Some good some not so good. But the most important one was bring attention to our heathcare system which is fundamentally flawed and we still have a long road ahead.

    [Reply]

    Nancy Sathre-Vogel Reply:

    @Greg Ramos, Agreed. The ACA has gotten us talking. It’s not perfect, and will need to be changed over the next few years, but it’s opened Pandora’s Box, so to speak. Now, if a party wants to repeal it, the American people will demand that it is replaced with something making provisions for health care for all Americans.

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  3. Tiffany December 18, 2013 at 8:38 pm #

    An interesting read Nancy. Thank you.

    I’m so glad the ACA will benefit your family for the reasons you mentioned. Although it is not currently a benefit to us (because our premiums through our employer sponsored plans have gone WAY up), it may benefit us in the future when we strike out on our own. I mention that to preface what I am about to say. Although we may benefit, I am opposed.

    Here’s why: It’s not sustainable in the current form. It’s not just “imperfect”, it’s not sustainable. The model relies on lots of healthy young people, currently uninsured, signing up. These young people are intended to balance the books for those more expensive people, such as my family, with pre-existing conditions. These young people are not signing up – yikes!! This cost-pooling is central to the economics that underpin the law, and if young people decline to enroll, costs for everyone else will skyrocket (driving more people out). This is despite the $700B+ that has already been spent on advertising and target marketing to get these folks signed up. Did you see/hear any of the ads before Thanksgiving? I did.

    Anyway, felt it important to share my point of view. One other thing…

    “I’ve had a few people try to explain why they were against it, but so far I’ve never heard a logical argument against.

    The propaganda is deep here in the USA these days. Opponents of the ACA talk about death panels and government mandates of certain procedures. They claim Obamacare is killing jobs and that socialized medicine equals communism. Mostly what they say is flat-out false, yet there are many who believe it.”

    I am an opponent and I do not talk about death panels and government mandates of certain procedures; I don’t mention killing of jobs and communism. I actually quite resent being painted with this broad brush of assumption.

    We’ve paid a lot of money for health insurance over the years, and benefited when we needed it. I’ve had 7 surgeries, including an emergency one. My son had an emergency brain surgery and spent a month in PICU. Boy were we happy we had insurance. Who paid for all that? My employer and I (and the other insureds). My employer is self insured by the way (so they aren’t some “big bad insurance company.” We have always made sure to have insurance, so we are believers in being covered. And, we’ve been fortunate to have our family covered at all times through one of our employers. No, I don’t believe the “old” system was better or good. Yes, I believe we need reform. Just needed to share my thoughts.

    [Reply]

    Nancy Sathre-Vogel Reply:

    @Tiffany, Thanks Tiffany – I appreciate your thoughts. I know there are issues with the ACA and it will change and morph as time passes. That said,it’s a start. And if we, as a nation, never start on the path to heathcare reform, we’ll never get there.

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  4. Fite Logic December 18, 2013 at 11:56 pm #

    Hello Nancy. Thank you for your relatively measured comments about the ACA. After reading your post, it is clear we have differing views about the law and its impacts, and I appreciate the opportunity to voice my concerns in what I hope will be an equally respectful way. While I do not claim to have your diverse life experience, I have mine, which I think provides its own, legitimate point of view. I do not expect to change your mind. I do hope, however, that my comments/rebuttals will cause readers to overlook the propaganda we agree seems to control this issue and come to their own opinions about the ACA.

    You say “health care” in our country was “broken” before the ACA. I think this begs the question of what you mean by “health care” (vs. health insurance) and “broken”. Though they are related, I think distinguishing between health care and health insurance is important. My understanding is most people were satisfied with their own health care before the ACA, though everyone agreed costs (and to some disagree insurance premiums) were rising at an alarming rate. Some believe costs are increasing because health care is being provided to those who need it but will not/cannot pay (thereby shifting the costs to others), or is being provided in excess because the “normal” transactional incentives do not exist (i.e. the consumer does not pay for the treatment directly), or because liability issues have increased malpractice rates, etc. My guess is the causes are mixed and complex. I think it is important, however, not to assume a lack of health insurance necessarily equates to a lack of health care. That said, I agree that the pre-ACA health insurance system was problematic for some. I suppose “something needed to be done”, and the ACA is “something”.

    You say the ACA fixed the worst parts of our system, starting with allowing 26 year olds to remain on their parents’ insurance plans, protecting these 26 year old “kids” from being “kicked off” those plans and left with no health insurance at all. I’ll try not to dwell on how it is that we’ve created a society of perpetual adolescents to the point that 26 year olds are still considered “kids”. My only question is, if 26 year olds are worthy of special protection, why stop there? My sense is you would agree that we should not stop there, and we should have single payer health insurance. That’s fine, but I think we should be honest about it and not suggest there is something special about being 27. Also, I would argue that the alternative is not necessarily those early twenty-somethings having no health insurance at all, at least not against their will. Many of those same “kids” have been extremely slow to sign up for coverage under the ACA (subsidies and all) suggesting maybe the problem was not that they could not get insurance, but that they were choosing not to. I’m not saying this is responsible of them or fair to the rest of us, just that it’s more complex than it might appear.

    You also note that the ACA fixes the problem of those with pre-existing conditions being denied insurance. I understand the moral argument that insurance companies should not be able to deny coverage to those with pre-existing conditions. At the same time, it’s not just that insurance companies only want to cover healthy people. What makes insurance work is the voluntary pooling of risk among those who may need the insurance. Forcing companies to take on guaranteed liabilities and not expecting them to significantly raise the costs to everyone seems untenable to me. Forcing coverage may the moral thing to do, but it is intellectually dishonest to think these additional costs will not be paid by everyone. What this requirement really does is convert an insurance program to a welfare system. It’s no longer insurance. I’m not necessarily against it; I just wish everyone was honest about it.

    You also applaud the removal of the lifetime max, which will help those people that otherwise reach their maximum coverage and “have no choice but to drop out of the treatment and die.” In a true health insurance system (risk pooling, etc.), I agree there should not be a lifetime max. I’m not sure the only alternative for every person that reached his/her maximum is to simply “drop out and die” as there are some (though not currently enough) charitable alternatives. In any event, I think we agree here. Of course, combining the pre-existing condition mandate with the “no max” mandate creates a more expensive welfare system. We can disagree about whether this is a good idea, but I would not consider it insurance.

    Yes, there are now “guidelines for what a health insurance plan must cover.” I wonder though, if a health insurer must cover it, is it really just a guideline? Setting aside the religious arguments regarding mandatory contraceptive coverage, etc., why should all insurers be forced to cover (and all insureds/taxpayers pay for) prenatal care, substance abuse treatment or birth control (to name a few) for everyone? I’m pretty sure I will never need substance abuse coverage, and would prefer to leave that behind and enhance my prescription coverage. I fear that people can no longer choose limited plans that fit their needs, and now are forced to pay for standardized, excessively broad care, for everyone, whether it is needed or not. This is not likely to increase, not decrease, costs.

    You mention the cap on maximum out of pocket costs. This is great for some, including me. For those that are forced to pay higher taxes to support the subsidies of others, however, the costs are higher, even if they come out of a different pocket. Again, maybe that’s OK, but the money has to come from someone.

    Similarly, you mention that preventive care is now free, which should lead to early detection of health issues and better outcomes. I agree increased preventive care may improve outcomes, but it is not free. Those costs are simply rolled into the rest of the plan costs, which may or may not be subsidized by others. If you mean there is no out of pocket costs for preventive care, please see my response above.

    I agree that there is something inherently attractive in forcing insurance companies to pay a certain portion of their revenue towards costs of care, so that they presumably cannot raise rates and “pocket profits”. I do not run an insurance company and have no direct skin in the game, but I’m uneasy when the government orders a private company to spend a certain amount of money a certain way, and issue refunds for any “overcharging”. I think history should caution us before we turn over historically private or quasi-market driven relationships to government control. This is really more an argument about the size and role of government in our lives, and you appear more comfortable with a larger, more powerful government. I do not trust insurance companies because they are run by humans, which are at best imperfect and at worst, hungry for money and/or power. Sad thing is, governments are also run by humans, and at least I can change insurance companies from year to year.

    Finally, you laud the subsidies for low income people to “help them pay for the insurance premiums”. Again, this is more about philosophy and semantics, but if person A is forced by the government to give money to pay for something for person B, has person B actually paid anything?

    I am against the ACA, mainly because (1) I prefer smaller government, and (2) I do not think anyone, of any party, is able to understand the ACA’s long term impacts on our society and economy. I mention society first because, despite its benefits (which exist for some), I think the ACA will accelerate our pattern of increasing government dependency and decreasing individual responsibility for all. While going down this road will inevitably result in economic collapse, it will be accompanied by a continued erosion of our freedoms which, frankly, is more important as it has underpinned our economic power, among other things.

    As soon as the ACA was passed, and the individual mandate was deemed permissible under the Congressional power to tax despite apparently being unconstitutional under the commerce clause, I felt that we should just go to a single payer system and stop the dog and pony show. Just to be clear, I think a single payer system will end up being worse that our current one for the majority of Americans, providing fewer benefits at a higher cost. For all of the comfort many find in the idea of a single payer system, it is worth noting that single payer systems are far from perfect, too, hence the persistent (growing?) market for private medical care in single payer system countries. There are no solutions, only tradeoffs. I’m just resigned to the belief that a single payer system is inevitable and I want to cut to the chase and avoid the political theater.

    I’m generally a libertarian, though I belong to no political party. I sit next to an unabashed socialist at work. We love discussing these things because we know we are both good people that happen to have major philosophical disagreements about the role of government in our lives. Our disagreements need not make us enemies. Thanks for taking the time and letting me weigh in.

    [Reply]

    Nancy Sathre-Vogel Reply:

    @Fite Logic, Thanks so much for your thoughts Ben! I appreciate that we can have respectful discussions about such a hot topic. I agree with your summation that it comes down to who you trust more – corporations or government. It’s a tough call.

    [Reply]

  5. Jade January 9, 2014 at 8:27 am #

    As a Canadian I find the whole thing about Americans not wanting universal health care baffling? Why wouldn’t you want something that is not only good for you, but good for all of society? And yes I pay tax for my universal health care, but let me tell you, it is much less than your “cheaper” health insurance option. I now live in Australia and I think I pay maybe 100 or 200 dollars for the medicare levy a year. They recently found a tumour on my husbands spine. The operation lasted 13 hours, he needed 10 litres of blood transfusion, needed a traciotomy and feeding tube and stayed in hospital for 2 months. He also had a metal halo, and the feeding tube for 6 months. The hospital did all the tests for free, the stay was free, the operation was free, even the liquid food was free… it was free even after we left hospital.

    If this had happened to us in the USA, he would have died. It was operation or death and there was no way we could have afforded it if we were Americans.

    [Reply]

    Nancy Sathre-Vogel Reply:

    @Jade, Holy cow Jade! That must have been scary!

    I think the issue in the USA is that people are used to our system. They know it. Even though they know there are issues, they are not capable of visualizing anything better. If only they would travel to other countries, they would learn.

    [Reply]

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