Ah, health insurance benefits . . . not the funnest or
funniest topic to start in on a blog. Unfortunately, it’s a topic I deal with a
lot (Boo!). As a Physical Therapy Aide for a local clinic, I do a lot of
calling, sitting on hold and then quickly writing down a client’s benefits. But
today, I’ll start with my own adventures in Obama Care.
Let me start with a caveat. I am not an ultraconservative, Rush
Limbaugh-worshipping Republican who has an ax to grind with anything our
president Obama touches (that would be my dad). I consider myself apolitical
and apathetic, not that I don’t care about the issues, but that I feel the
political situation is so corrupt and entrenched that the chances of me
actually getting my way politically are highly slim. That’s also unlikely because
I’m sort of an oddball politically. I’m Pro-life and Pro-freedom-of-religion.
On the other hand, I’m also a Pro-green conservationist, Anti-war, who is way
more liberal than most of my family members about social issues. I usually vote for a 3rd party
candidate; Green, Libertarian or Constitution Party candidates have all gotten
my votes. Not because I am suffering under the delusion that one of them would
win, but because I want to use my vote to say “This one tax payer hates your
two stupid parties”. I vote my conscious as much as I can. As Ralph Nadar said
in the 2000 election- “The lesser of two evils is still evil”.
I originally signed up for Obama Care the week before the
exchanges closed. My husband was already covered by Medicare, and my children
were already covered by Child Health Plan Plus (CHP+)- so it was just me. I found a plan that I could actually afford
for myself ($1.10 a month was my premium, and my deductible was $6,600). After
I hit the deductible, all further expenses would be covered at 100%. The
chances of me hitting the deductible if I have a good year and avoid the 3
C’s (Car Accident, Cancer or Caesarean
Section) are virtually nil. (Which is why the insurance company can afford to
offer this plan to begin with!) Basically, this is a catastrophic coverage plan
(wait- weren’t those outlawed?). The tax
credit (the amount that the insurance company would receive from the government
AKA the American People were paying on my behalf) was $294 a month. Since my
health care expenses since I’ve left the zoo have been $0 annually, I figured
this was my best bet.
In May, I decided to use my insurance for the one time I
would predict needing it for the year- to get an overdue Well-Woman Exam. After
all- preventative care was covered at 100% and no deductible applies, right!?
That is supposed to be everyone’s situation that has insurance now- sort
of a law- the Affordable Care Act thing.
In July, I receive a bill from my insurance company for $563.
This is a surprise to me because I am still assuming that my responsibility for
the Well Woman Exam with routine blood-work and a pap smear will be $0. I call
the insurance company. It turns out that the majority of the blood-work my
doctor ordered as preventative care is not covered under my insurance plan.
Somebody shot the preventative care balloon with a pellet gun!
Preventative care is valuable, the doctors tell us. I
understand the need for it- that is why I had gone in the first place. But it
is rather ironic that a plan will pay 100% for your healthcare when you are
completely well and 0% for your healthcare if you have any kind of problem
(isn’t that when you need the healthcare most?). The most ironic thing about
Preventative Care: If you choose to have a routine colonoscopy to check things
out, that is considered preventative care. Unless- during the colonoscopy- they
find a polyp. Then, the colonoscopy is no longer preventative and is probably
1000s of dollars. Mid inspection you go from free to cha-ching. Sounds pretty
terrible if you ask me.
Another insurance word I hate is “coverage”. According to one insurance plan I called
recently, their client had coverage, but she had a $200 copay per visit. $200 is over our typical charges for each
visit. It doesn’t sound like the patient is very covered after all! This also
applies to people who have a high deductible. They are technically “covered” but
when they receive a bill for a couple thousand dollars because they haven’t
reached their deductible yet, they probably don’t feel very covered. A lot of
these people will never reach their deductible. I feel especially badly for
those who pay hundreds a month for a plan. In our community, many of the working
class people have these sorts of plans, and that means a whole lot of dishes to
wash, shelves to stock or rooms to clean to be able to pay the bill. How much “benefit” is their insurance to them,
really?
As you get older, your health insurance costs go up as well.
My aunt and her husband, both in good health and semi-retired, pay nearly as
much for their monthly health insurance as I pay for my family’s rent. Of
course, I think it is a better plan. Still, I can’t imagine ever being able to
pay that much for health insurance. In a world where citizens in some countries
are starving, health insurance really looks like another American luxury.
Then there is the tax credit. Many people (myself included)
opted for plans that they could afford because they qualified for a tax credit.
Sounds like a good idea, right? First of
all, somebody is paying that money to the health insurance company. It’s
not like it’s free money, and it is not like they don’t actually collect it. If
the health plan receives $294 a month for as non-existent of a plan as mine,
how much are the American People paying for a plan that actually has a decent deductible?
A funny aside- We were recently watching an episode of Northern Exposure where
someone didn’t want to get into a fight because they had a high deductible of
$500. Now, a plan with a deductible as low as $500 is virtually unheard of.
At the end of the tax year, will my health insurance tax
credit mess up my tax refund? That is another question that hasn’t clearly been
answered. It most likely depends on how much or little the person makes. Still,
our family uses our refund to pay for anything extra or unusual that we can’t
pay out of our ordinary budget- licensing and insuring our cars, maintenance,
doctor bills. Large or unexpected expenses. I’m sure a lot of other people do
likewise. I’m curious to see how the
next tax season unfolds for the American People.
It seems the clear winners in Obama Care are the insurance
companies. If your income is low enough to qualify for Medicaid, then you
probably are a winner, too, depending on your outlook and situation. With my
new pregnancy, I was luckily able to switch from my exchange plan to Medicaid-
a far better situation for me and my family. Still, I know every new member of
Medicaid is still being paid for by someone. It’s not magic, people. At least
with Medicaid, the dollar amount paid by the American People actually will
provide real benefits to those covered. The losers of the Obama Care system
appear to be those who make too much money to qualify for the real benefits,
but not enough to pay the higher premiums of health insurance. This encompasses
many in the middle class. At a certain
high point of cost, I argue that the plan is no longer a benefit, and the person
would be better off without. Except if they had a catastrophic event. So now,
we just need a way to predict the future, and all will be well.
Fixing the system? My sisters are big fans of
not just bitching, but fixing. Despite the title of the blog, I am not too
wise, but there are things we could try. I see a moderate deductible partnered
with a Health Savings Account as having a lot of potential. If the government
set everyone up with a HSA for the same amount as the tax credit they are
giving to the insurance company, it would go a long way towards the person’s
yearly medical expenses. Lowering
premiums is a pipe dream- isn’t going to happen, but would be nice! Of course, there is my favorite fix to Obama
Care- NOT unfairly taxing those who still can’t afford health insurance or opt
not to buy it (after all it is still their money and they should have a choice
with how to spend it)! Another aunt has suggested setting up government-run
hospitals and clinics that anyone can use for free or a low copay. Probably
would cost less than Obama Care. Putting
everyone on Medicaid? Sounds nice, but look to Eastern Europe and Canada for
lessons on how this might affect our own economy! My dad, strangely enough, has
long held one of my favorite ideas. Eliminate all health insurance. Each person
pays his or her health costs directly. Without the insurance company middle
men, health care costs would come down, and people could actually afford to pay
their own bills. A decent HSA would go a long way in making this plan work. Are we better or worse off with Obama Care?
It depends on who you are and how much money you make . . . Is the healthcare
system fixed? Hardly . .
