SMOKINCHOICES (and other musings)

January 5, 2014

H/C Sticker shock

Health-care law

Sticker shock ahead for some, experts warn


CHICAGO — As  key enrollment deadline hits, many people without health insurance are sizing up policies on the new government health-care marketplace and making what seems like a logical choice: They’re picking the cheapest ones.

Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock next year when they get medical care and discover they’re on the hook for most of the initial cost.

The prospect of sticker shock after Jan. 1, when those  signed up for policies begin getting coverage, is seen as a looming problem for a new national system that has been plagued by trouble since the new marketplaces went online in the states in October.

For those without insurance  — about 15 percent of the population— “the lesson is, it’s important to understand the total cost of ownership of a plan,” said Matt Eyles, a vice president of Avalere Health, a market-analysis firm. “You just don’t want to look only at the premium.”

Counselors who have been helping people choose policies say many are focused only on the upfront cost, not what the insurance companies agree to pay.

“I am so deeply clueless about all of this,” acknowledged one new buyer, Adrienne Matzen, 29, an actor in Chicago who has mostly been without insurance since she turned 21.

Although she needs regular care for asthma and a thyroid condition, she says she’s looking for a low monthly premium because she makes less than $20,000 a year.

  • Hospitals are worried that those who rack up uncovered medical bills in 2014 won’t be able to pay them, perpetuating one of the problems the new system is supposed to solve.

The new federal and state health-insurance exchanges offer policies ranked as bronze, silver, gold and platinum. The bronze options have the lowest monthly premiums but high deductibles — the amount the policyholder must pay before the insurer picks up any of the cost of medical care.

  • On average, a bronze plan’s deductible is more than $4,300, according to an analysis of marketplace plans in 19 states by Avalere Health. A consumer who upgrades to a silver plan could reduce the deductible to about $2,500. A top-of-the-line platinum plan has the lowest average deductible: $167.
  • Comprehensive data on premiums isn’t available, but in one example, a 30-year-old in Chicago would pay an average of $222 per month for a bronze plan, $279 for a silver or $338 for a platinum.

The complexities of insurance are eye-glazing even for those who have it. Only 14 percent of American adults with insurance understand deductibles, according to one recent study.

The danger of a wrong snap judgment is great for those under financial pressure — especially those with modest incomes who make too much to qualify for the government subsidies available under the new system. Subsidies aren’t available for individuals making more than $45,960.

(My Comment:

Die-hards  such as me still can’t get over the fact that our President abandoned the single-payer concept even tho he ran on it – without even trying to start with it.  It’s the only thing which would have worked well as the organization was already in place with  the effective, successfully run Medicare and Medicaid which is already in place and could have just been expanded. It could have been paid for in our  taxes through payroll or income, proportionally. 

As I see it, what we have is a demand – the law – forcing people to comply  (read that as “NO CHOICE”) and in most cases, it is not what many want nor most can afford.   In my opinion, the monthly premium is enough of a deterrent, but with the complication of  the so-called “deductible” — it’s a flat-out NO-GO because of the desperate plight of the middle class.   Lookin’ good for Insurance Cos and BIG PhRMA.  Think doctors are a bit worried.

There are no jobs for our masses in this country.  This is not the worker’s fault as it was the corporate decision to ship the jobs abroad for economic concerns and it was allowed by our so-called government  decision-makers. It should have been considered a crime against the people for it has all but destroyed our nation and the lives of our people.   We’re having National discussions trying to raise the level of wages to somewhere around the $10 mark, which it must be stated might help a tad — but it sure won’t buy shelter, food  or any of the other necessities of everyday life.  The state of our economy has nothing to do with this problem at all, for it is centered around those well paid  and privileged of the upper or top most class who shall always be able to afford to buy whatever they want or need.   The affordable-Care- Act  will certainly be good for them as are many of the new rules and structures. 

It is the cost and deductible factors which make it untenable to the middle-class.  They don’t have the money for this.  It isn’t there or anywhere on the horizon.  The need for jobs has been priority one for over five years and not much has changed.  Some could say, it’s no better, or even worse.  All the talk about ACA and what it will bring to our long suffering people is only hype.  What good are all the new rules if one can’t afford to “buy” and pay for the coverage?    Great for the fully subsidized folks – but who among us truly aspires to be in a position to need to be fully subsidized?  People want a life they can be proud of which grants them dignity, pride and pursuit of happiness.  The American way of life just isn’t something to be proud of any more. 

And one more thing;  if I were say 40 or 50 – I’d really be up in arms because none of this coverage offered anywhere will cover the kind of doctors I choose to use – alternative care folks like naturopaths and herbalists etc.  I do not use mammograms or  pharmaceuticals and would prefer never to have to go to a hospital in my life.  Don’t take flu or pneumonia shots and am grievously opposed to  inoculations given to infant babies of any age.  If I were in mid-life — I wouldn’t go along to get along, I might start a revolution because this just ain’t right! It is obscene that people should  be forced to pay for or buy into something they do not want or believe in.    Where is freedom of choice, free will or constitutional rights? 

I struggle to make ends meet living as I do on Social Security, but I am required to cough up over $100  out of my Social Security for Medicare and I rarely see a doctor.  The last doc I saw was Dr Aukerman who moved to another city after leaving OSU’s Integrative roster.  There are a few really competent docs close enough to me, but they don’t take insurance because of the way they are treated (sub-standard) and since I am not wealthy,  I must do without. Hey, that’s the way the world works, you roll with it or DIY which is what I have managed to do.  Not for everybody, for sure, but it works for me.   Jan) 


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