, I truly feel for you and your family. I hope things get better and that this is just a bump in the road.
I don’t know if your experience is typical or not, and whether it’s due to the ACA implementation or just a streak of bad luck. There’s so much
controversy surrounding this topic that it’s near impossible finding unbiased, objective information. It seems people either love it or hate it,
even though they know nothing about it. A lot of folks hate it for no rational reason other than they’re just haters and want it to fail because the
Obama administration chose to implement it, despite the fact that the whole idea (including the mandate) was the brainchild of the Heritage
Sorry, I’ll try to keep politics out of this post.
I do know at least 5 people who’ve had positive experiences so far. I have 2 nephews and 3 friends that have told me they had no problems at all. My
nephews and 1 friend were unable to get insurance at all before ACA, but are now covered at very little cost. One nephew is finally able to get
medication for his COPD problem, and my friend is now seeing a specialist for a serious vascular problem (blockages, I think) that left untreated
could become fatal. Anyway, they all told me they had no problems enrolling and finding suitable plans.
I’m lucky, I guess. I’ve got coverage through my employer and didn’t have to go through the whole process.
I do know that the U.S., the richest nation in the world, stands almost entirely alone among developed nations that lack universal health care. As
such, we share company with only a handfull of others: a few of the Balkan states, and the Soviet-style autocracy of Belarus. Public spending on
health care per capita is greater in the U.S. than in all other developed nations.
Now, if you’re in favor of universal healthcare, then Obamacare is a step in the right direction, despite the system’s many faults. However, for
those who are adamently opposed to this idea, the Affordable Care Act is a living nightmare. It’s tax increases and unpredictability have many
worried for the future of the country.
Personally, I think it’s too soon to project an outcome. Change never comes easy and often takes a while to implement. I’m trying to keep a
positive outlook, as I think we’ve fallen behind the rest of the civilized world when it comes to caring for our people. There’s a whole lot that
needs changing about it, but it’s a start. Sometimes taking the first step is the hardest part.
For what it’s worth, the following is a list of pros and cons that I’ve compiled from a variety of sites. Most seem to have already made up their
minds about it, though, and so it may be of no value to them.
---32 million Americans are currently without health insurance. Thanks to this Act, a larger portion of the general
population will now have access to the coverage they need.
---Patients with pre-existing conditions cannot be denied coverage by insurance companies, and companies can no
longer drop someone once they get sick.
---The federal government will pay the states to allow low-income individuals to enroll in Medicaid
---The Medicaid “doughnut hole” gap in coverage will be eliminated by 2020.
---Each year, $125 million will go towards funding school-based health centers and programs to reduce teen
---States are required to set up insurance exchanges to make it easier to find the best deals on private health
---The number of bankruptcies caused by health-related issues will be severely reduced.
---Ban on discriminating against children with preexisting conditions: insurance companies can't deny coverage to
children under age 19 for a pre-existing condition. The ban will go into effect for adults in 2014.
---Ban on rescission: insurers will be prohibited from dropping a customer when they get sick or to search for errors
in customers' applications to use as a basis for rescinding coverage or denying payment for services.
---Ban on limiting coverage, lifetime caps: Insurers will no longer be able to impose lifetime dollar limits on
benefits--particularly hospital stays or expensive treatments for chronic diseases, cancer, etc. By 2014, they will
phase out annual caps.
---Ban on limiting doctor choice in new plans: insurers will have to allow primary care physician status for
OB/GYNs and pediatricians so that patients don't have to get pre-authorization or referrals to see these providers.
---Ban on restrictions on emergency services: insurers will have to cover all emergency care, in or out of network.
---Young adults can stay on their parents' plans til 26 unless they have access to coverage in their workplace;
---New plans will cover preventive care with no customer costs--well-baby, mammograms, colonoscopies, etc.
will be covered with no co-pays or deductibles.
---Obamacare does not apply to businesses with less than 50 employees. Larger businesses are required to offer
health insurance, but receive tax credits to help employees pay premiums. In 2015, the tax credit increases to 50%.
The CBO (and other non-partisan groups, as cited below) point out these disadvantages:
---There are 30.1 million people who currently buy their own private health insurance. Many of them ahave had their
plans cancelled by the insurance company because the plan doesn't meet the 10 essential health benefits. Their
costs of replacement insurance is higher because it provides services, like maternity care, that many of them
don't need. (Source: Factcheck.org, The Keep Your Plan Promise, June 28, 2012)
---Between 3-5 million people could lose their company-sponsored health care plans. Many businesses will find it
more cost-effective to pay the penalty and let their employees purchase their own insurance plans on the
exchanges. Other small businesses might find they can get a better plan through the state-run exchanges.
(Source: CBO, The Effects of the Affordable Care Act on Employment-Based Health Insurance, March 15, 2012)
---Increased coverage may actually raise overall health care costs in the short-term. That's because many people will
receive preventive care and testing. These additional tests, such as cancer screening and cholesterol tests, will
lead to higher medical spending. (Source: CBO, 2009 Study on Preventive Health Care, August 7, 2009)
---About 4 million people, or 1.2% of the population, will wind up paying the tax rather than purchase health
insurance. The CBO estimates this will cost them $54 billion.(Source: Washington Post Factchecker,
Tax Breaks vs Tax Hikes, July 6, 2012)
---In 2018, insurance companies will be assessed a 40% excise tax on "Cadillac" health plans. These are plans with
annual premiums exceeding $10,200 for individuals or $27,500 for families. Many of these plans are for people in
high-risk pools, such as older workers or those with dangerous jobs. Most of the tax will be passed onto the
companies or employees, raising premiums or deductibles. (Source: Kaiser, Cadillac Tax Explained, March 18, 2010)
My positive side tells me that perhaps one day we’ll look back on it and wonder why we didn’t do it sooner. My negative side tells me, however,
that we may blow ourselves off the face of the Earth before that day ever comes...