What’s next for your wallet and your health with Obamacare? Likely it will be a continuation of sticker shock as you face the new out-of-pocket payment requirements for needed health care and services.
For some, benefits don’t “seem” much different. That would be wrong. Even if your insurer provided you with health insurance options that seem “almost” the same as what you had before, even if Obamacare takes a backseat in media as other stories grab headlines, few “know” what their healthcare experience will look like this year.
Obamacare is a law that is still being examined, tweaked by stakeholders urging changes to this or that. One thing is certain, consumers are ill-advised not to pay attention to and insert their voices into desired changes that we require in order to function in a post-Obamacare world.
The first crucial item that we must understand is that there is an ever-growing market of underinsured. The PPACA worsened this problem with its focus on mandating “some” insurance under the threat of a tax for non-participation in order to further governmental intentions to get people insured so that politicians can boast of the reduction in the number of uninsured.
You need look no further than the really crummy options of catastrophic plans and plans that cover 60 percent of costs (bronze-level) and use elementary math to realize this sort of coverage only works if you don’t need medical care and treatment and otherwise poses the risk of financial ruin to someone who needs medical care and treatment.
This sort of reasoning, any type of insurance as long as you have insurance is old-fashioned, and in spite of being codified in the “New” law has always jeopardized patient physical and financial health in the event of illness and the need for medical care as the product we purchase to help pay for needed medical care, health insurance proves insufficient in the face of ever-rising needed medical costs and ever-lower actual coverage of needed medical care.
We’ve already seen new limitations on available providers with discussions of inadequate provider options. We’ve already seen new ways of limiting insurance coverage through higher premiums, higher co-payments and/or co-insurance, higher deductibles. We KNOW that Obamacare worsened this situation through its effort to standardize the industry by making requirements for health plans which used those requirements as an excuse to raise prices.
There are other signs. In my August 5, 2013 post, “The Republican Private Party,” http://conoutofconsumer.blogspot.com/2013/08/the-republican-private-party.html, I referenced the front-page “NY Times,” article touting the growth in medical tourism, leaving the US for needed medical care in order to manage costs. Obviously, in a well-functioning healthcare system, there should be less of a focus on this option which essentially says, “I cannot afford needed medical care and treatment in my country, I have to go somewhere else.”
Obamacare and its focus on “consumer directed” health plans encourages what many of us have already seen, higher deductibles, worse coverage, just to be able to afford health insurance. Not quite as high as their HSA alternatives, deductibles for more traditional plans are going up, as well, meaning our out-of-pocket liability for consumers is also going up.
At this point, this HSA-style has infiltrated other plans so that the amount you’ll pay to avoid high deductibles is now nearer to that high deductible amount. Raising deductibles for more traditional plans indicates that insurance companies are moving towards the HSA high-deductible model, which will create a larger class of underinsured individuals in the event you need coverage for illness.
Likely, you’ll also notice the shift from co-payment to co-insurance, another way to charge consumers more so that instead of paying a flat fee in the usual way for a service or product, such as $10 or $25 dollars, now consumers will pay a percentage of the cost. In the case of participating providers the percentage will be lower than the percentage consumers will pay if they use out-of-network providers.
The push for HSAs, which was discussed here in 2008 in, “Health Savings Accounts: If you’re healthy any insurance is good enough,” were and are plans that typically work ONLY for the healthy or wealthy, or both. Soon, with the added impetus provided by Obamacare, HSAs will become the norm as better insurance coverage becomes unaffordable and is less meaningful because insurance companies make them only “slightly” better in terms of cost and coverage than HSAs.
The way we pay our bills will require more cash up-front as physicians worry about getting paid. This change is reflected in an article by Wayne Lipton entitled, “Don't Just Collect Patient Payments at Your Practice; Provide Value,” on July 25, 2013 (See more at: http://www.physicianspractice.com/blog/dont-just-collect-patient-payments-your-practice-provide-value#sthash.CCFMfQmV.dpuf).
In discussing how doctors will collect their fees and advocating for concierge medicine, where patients pay a retainer on an annual basis for a primary care physician frequently in combination with additional cash payments, Wayne Lipton states that under the Affordable Care Act, “Unfortunately, a lot of patients don’t understand the law and aren’t yet aware of the potential out-of-pocket costs. Most will come to the doctor’s office with their brand new insurance cards and pent up medical needs, not knowing that the cost of the first wave of services is coming directly from their own pockets.” (See more at: http://www.physicianspractice.com/blog/dont-just-collect-patient-payments-your-practice-provide-value#sthash.CCFMfQmV.dpuf)
The insurance company organization AHIP in June of 2013, in an article entitled, “January 2013 Census Shows 15.5 Million People Covered by Health Savings Account/High-Deductible Health Plans (HSA/HDHPs), informs us that there is an annual growth rate in HSAs of “approximately 15 percent over the last several years.”
By now, those scratching their heads at how words like “success” can already be getting tossed around with Obamacare when many of its provisions are only now impacting people’s wallets and health will realize what we didn’t when Obamacare was enacted, success for politicians is based on overall numbers of insured individuals without attention to whether or not that insurance does its job and provides financial capability for individuals to pay their bills if they need medical care and services.
It is this huge divide between how the government measures “success” and what we need from a health insurance product that will be the beginning of the story for 2014. For many, based on a consumer measure of success, Obamacare is a failure so far as we were forced to choose worse coverage than last year or pay more for similar coverage. This issue was addressed in, “Ask Them to Explain ‘Better Coverage For Less Money,’” on 12/31/13, http://conoutofconsumer.blogspot.com/2013/12/ask-them-to-explain-better-coverage-for.html.
