Does The Affordable Care Act Really Benefit All?

I was compelled to write this as a response to an article I read by Cat Giordano titled “How Does the Affordable Care Act (ObamaCare) Benefit Every American?” I agree that many of the statements are accurate. I have been working directly with the public since the Healthcare Exchanges rolled out from day one. I have seen the joy and the pain that my clients have experienced while being forced to comply with the law. It has been a true benefit to many but not to all. Some have seen it as a real burden.

In this article I will mention some of the key points in the article and why they some people have not seen them as a benefit. What I write is simply my opinion based on what I have personally observed. I personally still carry a pre-ACA Plan that cost about $200 less than a comparable ACA plan minus , maternity, mental health and substance abuse benefits and a taxpayer subsidy contribution which I like many others would prefer not to have. So far it has worked for me but it is in danger of ending on December 31, 2017.

First there were things written in the law that were included in good faith as a way of making sure that everyone could get unlimited care no matter how sick they are or how often they need care. To make this possible they included a ban on refusing insurance to anyone due to a Pre-Existing Condition. They also put a ban on lifetime limits and put a cap on annual out of pocket expenses. All of these were what insurance companies used to control cost. Since those limits are no longer there they have passed the extra cost on to the consumer. This is an expense that is felt by people who receive very small subsidies or no subsidies at all. Though it is a benefit to some many consider the extra expense to be more of a burden.

Mid and Large groups employers are required to provide insurance for all of their full time employees. That has been both a blessing and curse. While they do need to provide insurance for their employees if they make it “available” to the employees spouse and dependents but do not offer to contribute towards their premiums it can cause a financial burden to the family. Since they have insurance “available” to them they automatically do not qualify for subsidies through the exchange. If the family cannot afford the unsubsidized premiums on the exchange many remain uninsured and depending on their income may also incur a penalty. So some have benefited while many others did not.

Also many people have received contraceptives and certain preventative medical test without any upfront cost. The misconception is that the services are free. They are not. The cost are passed on to the consumer with higher premiums which is felt mainly by those with very low subsidies or those who do not qualify for financial help.

Children can now stay on their parents plans until age twenty six. This is mostly beneficial when it is an employer based plan. Again this is not for free. Employer based plans generally have more benefits than comparable plans in the individual market and is a plus for the young person that is just getting started in life. It can be a hassle when applying for a child under twenty six on the exchange that is also a taxpayer. Multi-taxpayer households often cause errors on the Marketplace application.

Medicare recipients did receive a great benefit when the prescription benefit donut hole was closed saving many seniors money on their drug cost. Medicare premiums and deductibles did not go down from 2016 to 2017. Medicare part A premiums are free for most although some do have to pay a premium depending on their circumstances. Medicare part A hospitalization deductibles rose from $1288 in 2016 to $1316 in 2017. The Medicare part B premium rose form $104.90 in $2016 to $134 in 2017. The Medicare part B deductible rose from $166 in 2016 to $183. These can be verified on Medicare.com for 2016 and on Medicare.gov for 2017. Though they were very small increases it still cannot be said that the deductibles and premiums for Medicare are lower.

The two groups that do get a price break are women who cannot be charged more solely based on their gender. This was verified by running an illustration on a 50 year old male and female in Fairfax County , VA on healthcare.gov both earning $48,000 per year. The cost is the same for both at $412.97 per month for the lowest cost silver plan without a subsidy. Premiums for older people under 64 cannot be more than 3 times more than younger people. This is a benefit when they receive a subsidy but a burden when they do not qualify for the extra help. The lowest price silver plan for a 64 year old earning $48,000 in Fairfax County VA cost $693.44 with a $6075 deductible with some first dollar copay benefits for doctors visits lab work and certain prescription drugs. The lowest price bronze plan cost $586.89. Both plans include 1 annual preventative care cost at no cost. Beyond that the bronze plan is a straight deductible plan which covers certain generic drugs for $5. One$1 more than Walmart’s discount drug plan.

Medicaid expansion for the first time made it possible for lower income single people to get the healthcare they needed outside of going to community clinics that cared for them on a sliding scale bases regardless of income. Though this was a great benefit to many, when people receive things that they view as a free service they become blind to the true cost involved. The community clinic that I went to when I was uninsured due to a pre-existing condition a few years ago had a minimum copay if $10. Giving people the impression that something is free and not having them to contribute at least $1 to their care is not a benefit but is doing them a disservice. The safety net should be there when needed but people should be made aware of the true cost.

Subsidies were seen as a blessing to some but as a burden to others. For families that use to be able to afford their pre-ACA insurance plans which included the benefits that they liked were now forced to accept subsidies in order to be able to afford the newly designed plans. It was accept the subsidy and buy the insurance or don’t buy a plan and pay the penalty. It has proven to be a real challenge for self employed individuals whose income fluctuates throughout the year who often forgot to constantly update the changes in their income. I always make it a point to let my clients know the true cost of their policy. Then after they recover from the shock I let them know that because they qualify for a government subsidy they get a lower price. I have found that doing this gives them a little more appreciation for the discount they are getting.

The mandate is something that people hate when they do not understand how our healthcare system works. There are no taxes collected to prepay for our healthcare. Everyone wants to take out of the system but many do not want to pay into the system. Everyone should have to pay something to contribute to the cost of their care. If people were allowed the choice to keep their pre-ACA plans instead of them being cancelled like many insurance companies and states chose to do, they could have continued to pay into the system paying something that fit their budget instead of opting to go uninsured due to the higher prices and deductibles. Contrary to popular belief not all companies cancelled their pre-ACA plans and many of them still exist today. Since the decision was left up to the states and the carriers many lost these plans not directly due to the ACA but due to the decision of one of these entities. The policies written between 2010 and 2013 are in danger of ending at the end of 2017. People like myself will not see it as a benefit because we will lose the plans that we like. You can find more about transitional grandmothered plans in your state by looking for the article “Like your grandmothered health plan?” on the healthinsurance.org website where you can find a link to see documents showing how these plans are being treated in your state.

So I do agree that some people have enjoyed benefits from the ACA but I am not blind to the ones who see it as more of a curse than benefit.