Affordable Care?

Well, according to the stats I’ve been seeing bandied about, an average of about 1% of people who looked at the myriad websites offering health insurance exchanges actually signed up.

My state doesn’t offer an exchange because they opted to go with the federal option.  Knowing this over a year ago, I discovered that my husband and I would only be eligible for the pre-existing conditions option.  The cost, at that time, for a plan with a $2000 deductible and 70/30 coverage:  $590 (if I remember correctly, I didn’t write it down or anything).  Given that both of us are in school, and neither of us works full time, that’s simply out of our price range.  In fact, it’s within $100 of our mortgage payment, the single biggest bill we have.

I’ve spoken with others in a similar situation.  This Affordable Care isn’t affordable for the majority of people in our situation.  It’s just not an option, even if one does forgo satellite TV, weekends out, and eating out.  Those savings still don’t add up to the costs associated with the Affordable Care Act.

I’ve done some research and discovered that if one is not eligible for a plan, or if one has religious objections, one can opt out.  But, probably most importantly, I discovered that the penalty is not legally enforceable by the IRS — they can’t collect it, nor can they charge interest or penalties on the unpaid penalty.  The key is to order one’s taxes so as to not get a refund (which should be the goal anyway, so that the government doesn’t get to use OUR money interest free) in order for them not to deduct the penalty from one’s refund.

I also discovered that if one waits until they are sick and goes to the ER, they will be offered the opportunity to sign up for a plan then.  The first 30 days of coverage are paid for by the federal government, and the next 60 days are paid for by the hospital.  So you can get sick and have it paid for, and need never make a payment.  I’m not sure that the hospital can’t come after you in collections if you don’t pay, but I’m also not sure that’s not any different than things stand now for a lot of people who utilize the ER for illness.

From the little I can understand by reading others’ take on this act, the idea was that people like me, who will be paying for the insurance, will be subsidizing those who make too little and get theirs paid for.  To me this seems like a sneak tax increase; we are forced to pay over $7000 a year in insurance payments for a product we can’t afford to  actually use, and our payments go toward subsidies for better quality insurance for those poorer than ourselves, who will actually use the care.  I would prefer it if there was an actual tax increase and everyone just got medicare.  Medicare is by no means the perfect system, but it is the best we’ve got other than maybe whatever platinum plated plan our Congress gets.

I also discovered that, while insurance companies have been jacking up their rates in advance of this taking effect, and will continue to jack up their rates, that actual reimbursement to providers and facilities is expected to go down by 25% in the next 5 years or so.  So if you get sick and need to be hospitalized, you are going to be in a facility that has staffing stripped to the bone with all the opportunity for mistakes and neglect that entails.  Not to mention the level of overwork and burnout all staff will be dealing with, and the lowered wages coupled with increased workload that will inevitably come; administrators aren’t going to take a pay cut to ensure the line staff have a manageable workload, I can assure you of that.

Rural hospitals may end up closing as a result of this act.  In fact, up to a third of hospitals nationwide, in rural, suburban, and urban areas, may close.  The ones that are left will be hard pressed to offer services.  I believe we may end up seeing cash only facilities spring up as a result of this; for those who can afford it, that is.  The good news (if there is any) about cash driven facilities and providers is that they don’t have to pay for an entire office staff devoted to dealing with insurance companies.  They have eliminated a huge cost outlay.  The average claim is denied at least once before being paid.  It usually takes 3 weeks or so for the denial to ensue.  By the time a claim is paid, it’s months down the road. For Medicare, the time lag is closer to 6 months.  I don’t know about you, but if I’m owed money, I need to have it when it’s due or I can’t pay my own bills on time.  By making the business cash only, a provider can eliminate a credit line and at least 1 full time salary (office manager/billing specialist).  That savings is passed directly onto the consumer.

As usual for the government when naming something, the name of this act in actuality means exactly the opposite.  What particularly pisses me off about this however, is it’s based on a Republican plan — but because a lot of Republicans are racist (it’s where they all migrated to after the Democrats became liberal and social justice supporters), the fact that a black man happened to be in office when this became law, means it’s now the evil Obamacare.  Well, it was Romneycare before it was Obamacare, ask anyone in Massachusetts.

I’m against this act by any name, for the simple reason that it’s a giveaway to health insurance companies rather than anything that will actually get health care to citizens.  Even when I had health insurance, I couldn’t afford to go to the doctor.  And Obamacare does nothing to change that, it actually makes it worse by imposing the purchase of a private for-profit product on citizens.

I’ve heard all the arguments that it’s just like car insurance, and that is mandated.  But the key difference between the two is that you don’t have to drive.  You don’t have to own a car.  No, really, you don’t.  Not having one might limit your mobility, or make it more inconvenient to get where you want to go, but it’s not necessary for having and keeping a job, or for participation in life.  They are not the same at all.

Health care is the next bubble, before education loans even, in my opinion.  The costs are unsustainable and ACA does nothing to change that.  It may in fact speed the bursting of the bubble.  I just hope I can finish school before it all comes tumbling down around my ears.  It’s going to be a long while before the traditional apprenticeship model (as opposed to formal schooling with a test and a piece of paper at the end) of medicine and nursing is acceptable again.

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