It’s remarkable how anti-consumer the Affordable Care Act is. As discussed yesterday, within its approximately 1,000 pages there was no simple fix requiring insurance payers whether public (government) or private insurers to dedicate money to reclaiming some of the billions of dollars paid out and ultimately passed onto consumers for fraud.
Further, the 80-20 rule created by Obamacare that forces insurers to “refund” money they can’t shove into the 80 percent for claims payments and administrative costs does NOT permit expenses for investigating and recovering money from fraud.
Nor was there a single line about providing for monetary rewards for individuals who pinpoint, document and inform insurers about fraud. These three changes would have helped keep consumer costs down by preventing the fraud expense of companies and government.
Now on the heels of a NEW YORK TIMES, September 16, 2015 article by Robert Pear, “Health Care Gains, but Income Remains Stagnant, the White House Reports,” http://www.nytimes.com/2015/09/17/us/politics/census-bureau-poverty-rate-uninsured.html?_r=0, we’re faced with another question about another anti-consumer provision of Obamacare…
WHY ISN’T AN INCREASE IN THE OUT-OF-POCKET MAXIMUM hinged to the US economy?
We know that if you are earning the same or less that increased expenses means you have less money. We know that already the broken presidential promise of providing consumers from relief from the financial peril in the face of illness has already left many of us worried.
Why didn’t the law provide that out-of-pocket maximums would be frozen at current rates UNLESS a US worker’s income went up comparably so that at least we could break even?
It’s more evidence of the anti-consumer approach of Obamacare. Quoting the democratic Economic Policy Institute President, Lawrence Mishel, Mr. Pear’s article reports:
“Despite decent employment growth in 2014, the persistent high unemployment yielded no improvements in wages and no improvement in the median incomes of working-age households or any reduction in poverty,” http://www.nytimes.com/2015/09/17/us/politics/census-bureau-poverty-rate-uninsured.html?_r=0.
Which explains why the only “news” you’ll read about this law is how more people have insurance. Again, not rocket science…You create a law that makes more people eligible for free health insurance (Medicaid) and threaten the rest of the population with a financial penalty if they don’t buy the product, more people have the health insurance product. It’s neither news nor newsworthy. But it’s really all Obamacare fans have unless you still buy into the threat that things could have been worse without Obamacare, a threat that cannot be proven, because we do have Obamacare.
Going into this benefits season we’re informed that premiums are up across the board (which are omitted from out-of-pocket maximum) and the old-time get less coverage or pay higher deductibles, copayments and coinsurance in order to “manage” those premium costs remains true. Further, the out-of-pocket maximums that families and individuals have to pay has gone up, $250 for an individual up to $6,850 and $500 for a family up to $13,700.
So thanks to Obamacare’s failure to freeze increases in out-of-pocket maximums when our economy is as bad as it is for consumers, we’re going to be paying MORE, which means we’ll have less money available for our households.
And remember, simply reaching your out of pocket maximum does NOT mean you have no medical bills. Review healthcare.gov…only ESSENTIAL health benefits in network are covered at 100 percent after you cross the unfortunate threshold of paying $6,850 out of pocket as an individual or $13,700 as a family.
There is a POSITIVE under Obamacare and the out-of-pocket maximum which is the inclusion of “…deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits,” towards out of pocket maximum. This IS an improvement in terms of CALCULATING your out-of-pocket maximum for the purposes of predictability and any recommendation to get rid of Obamacare should keep this provision.
Likely motivated by the desire of payers to move everyone into Health Savings Accounts, the high deductible product that was designed for the healthy-wealthy that features a HIGH DEDUCTIBLE with the requirement that such high deductible be counted towards your out of pocket maximum makes these plans more feasible for consumers under Obamacare.
Still, healthier people will pay more out of pocket during a year with HSA-type plans because they'll be paying out money meeting that higher deductible. But unhealthy people will find that these plans become an option since they would have met their deductible either way. Don't count on SAVING money if this is your insurance unless you don’t need much medical care during the year.
Simply hinging an increase in out-of-pocket maximum to US economic performance would have provided consumers with needed protection, but it was omitted from Obamacare.
