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Affordable Care Act Not So Affordable After All

Affordable Care Act Not So Affordable After All

Health insurance consumers grapple with sky high premiums and deductibles

As it turns out, the Affordable Care Act is not exactly affordable after all.

With the third Obamacare open enrollment in full swing, consumers nationwide are reeling from health insurance premium sticker shock. Which explains why healthcare costs and access to healthcare remain the single most important issue to Americans.

A few weeks ago, we discussedthe issue of some health insurance markets suffering disproportionately under Obamacare. In the fourth largest city in the country, Houstonians will have the option of a grand total of zero independent Preferred Provider Organization (PPO) plans to choose from. Why? Providers say they can no longer offer independent plans for an affordable price.

Yet another Texas market faces the downside of Obamacare fallout. According to a new study, Dallas is the recipient of the nation’s largest premium rate hikes. Consumers not wanting to pay higher premiums for the same or less coverage are being encouraged to enroll in another health care plan. The Dallas Morning News reported:

Dallas County is the country’s major metropolitan area with the largest potential premium increase next year for people currently enrolled in the most popular health insurance plan on the Affordable Care Act marketplace, a new report shows.

Collin County residents who also are enrolled in the popular, lowest-cost silver plan through face an identical predicament as their counterparts in Dallas County, according to a Dallas Morning News review of the underlying data in the Kaiser Family Foundation report.

In both counties, a 40 year old adult who doesn’t qualify for subsidies and purchased a Blue Cross and Blue Shield “Blue Advantage Silver HMO” policy for 2015 will have to pay $1,116 more next year if he or she doesn’t shop around in the state exchange — and switch.

Forget about the commercials touting premiums as low as $22 a month for qualifying Obamacare enrollees. Many consumers (myself included), are in a situation where exorbitantly high premiums and deductibles are cause to wonder why we bother to cary health insurance at all.

Last week, the New York Times reported on this very issue.

But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.

“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”

In many states, more than half the plans offered for sale through, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found. Those deductibles are causing concern among Democrats — and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game.

“We could not afford the deductible,” said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. “Basically I was paying for insurance I could not afford to use.”

He dropped his policy.

…To those worried about high out-of-pocket costs, Dave Chandra, a policy analyst at the liberal-leaning Center on Budget and Policy Priorities, has some advice: “Everyone should come back to the marketplace and shop. You may get a better deal.”

But for many consumers, the frustration is real, as is the financial strain. In employer-sponsored health plans, deductibles have also been rising as companies shift costs to workers. Still, the average annual deductible in employer plans, $1,320 for individual coverage according to the Kaiser Family Foundation, is considerably less than the deductibles in many marketplace plans.

Those self-employed and subject to the offerings of the marketplace are hit the hardest.

But, as we’ve mentioned more than once — rate hikes and ridiculous deductibles are not the result of a glitch in the system, they’re part of the design.

Follow Kemberlee on Twitter @kemberleekaye


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It was never meant to be affordable.

    tkc882 in reply to Same Same. | November 18, 2015 at 3:18 pm

    And working as intended. The goal is single payer. By having government intervention drive prices through the roof then the obvious answer is a complete government takeover.

    It makes sense if you smoke a lot of pot. An I mean A LOT.

legacyrepublican | November 18, 2015 at 3:17 pm

Pelosi should have mentioned that passing the bill to find out what is in it meant that it was coming out of the rectum and it would be full of stinky crap.

Instead of quality health care, we got a stool sample.

Now that the bill is in the light of day we see that many, many people’s lives are adversely affected by the unaffordable Obamacoverage Premium LackofCare Plan, a Plan pushed by Health Insurance lobbies to secure future business with Big Brother’s help. Imagine the current VA system a million times over – our money going in and random care given out, if at all.

Let’s lose the overhead of insurance companies and gain affordable – major medical premium only HSAs – health care in the process.

Health care deductibles are accounting items that we can take care of ourselves using a doctor’s listed standard cost of care (sans the ins. co. overhead).

A wise person, grasshopper, looks not to those who caused the problem for a solution to the problem.

Nice pic Kemberlee 🙂

NC Mountain Girl | November 18, 2015 at 4:30 pm

There is some benefit to this both in terms of patients asking better questions about proposed treatment and doctors taking costs into their recommendations. Before Obamacare I found some physicians could be hostile to a patient who asked questions abut the cost effectiveness of what was being proposed. Today I have physicians offer ways to reduce out of pocket costs.

    Good gosh Mountain, we completely changed one sixth of the economy and socialized medical care so that you can ask questions. Now, that is real bright. Maybe you just should have changed doctors if they were hostile about any of your concerns instead of shellacking the rest of us.

      NC Mountain Girl in reply to david7134. | November 18, 2015 at 9:04 pm

      Good gosh, 7134. Where did I say I approved of Obamacare? I didn’t. I wrote there were some repeat, some bright spots, largely unintended, BTW. In fact, I pay the penalty rather than buy insurance. I have been self insured for over 12 years and I am economically ahead of the game. I also have excellent physicians because I simply won’t with up with anything else.

      Nor will I put up with comments from economic illiterates.

      This nation got into a decades long medical care cost spiral in part because people with tax free employer provide health insurance no longer saw a connection between the medical services they wanted and the cost of such services. The prevalence of third party pay also caused medical administrators to see the relationships to the institutional payers as more important than the relationship with individual patients. (Add in the insurance administrators plus each party’s lawyers and your exam room gets pretty crowded, doesn’t it? )

      Health insurance as a fringe benefit was a direct result of WWII wage and price controls. In order for any free market solution to work, the relationship between user demands and the actual price of procedures has to be reestablished. High deductibles do help do that. That you may not like them because they have changed the way you have to practice medicine is understandable. But all rational systems have to take true economic costs into account.

      The medical system has been riddled with economic game playing. The largest of these happens when medical administrators jack up what is billed, knowing the large insurance companies and government administrators will seek a deep discount. After some haggling and a long delay for payment, the bureaucrats on each side go back to their bosses claiming victory. The loser in this is the small player, who gets charged the medical equivalent of the car dealer’s sticker price.

      Take away the silly game playing and the bureaucracy needed to support third party payer and costs of actually caring for patients can go down as much as 20 to 25%. But those who have become used to having someone pay their bills will see this as a loss rather than a gain.

I have seen a most definite restriction in what I can do as a doctor. Need a stress test to assess that chest pain, forget it. Even if you have your same old health care policy, they will not approve this diagnostic modality. Cardiac ECHO’s are a big part of my assessment of a patient. They cost about $200 before Obamacare, now they cost $1300 and all, I repeat all of my patients are stuck with the $5000 deductible that was forced on them rather that their previous $500. Oh, and before some nut says I am doing the excess charging, that is the technical component for which I can’t charge, I still get the same $50 for reading the exam. Why can’t I charge the technical fee, because the bill forced doctors to refer these exams to special clinics that they can’t be a part of. The country has gone down the tubes and I am campaigning for secession of my state.

Surprise, surprise!!!! What did they think was in that 2,000 plus page bill? They believed the lies and the spin because they trusted the gov to give them what they believed they would get. They didn’t bother to investigate what they were actually getting or how any of it would work.

The “gift” that never stops giving.

Obama(care) is like a skunk that never runs out of spray.

I’ve signed up for a HSA-eligible bronze plan. I am stashing away money in my HSA for the time I need to be hospitalized. The contribution is deductible, the premiums are deductible, and if I pay for the standard medical expenses, they are also deductible.

The advantage of having insurance is the access to their negotiated price list. Every hospital & doctor have a much higher “list price” which people who do not have insurance have to pay. If you look at the explanation of benefits, the adjustments to the negotiated prices are very large.

I add the premiums & max out of pocket expenses to determine the max I’ll pay in a year. Luckily I have stashed enough in the HSA to pay this amount, if something happens.

BTW, my plan was canceled and I was put into a similar one for $150/month more. I could go to a cheaper plan, but I would have to get all new doctors and drive 20+ miles and past four hospitals in order to get to the allowed one. No thanks…I’ll go the larger network.

    NC Mountain Girl in reply to Liz. | November 18, 2015 at 9:19 pm

    Actually, the distortions in those “list prices” may be worse than you think.

    During my mother’s final illness, I had to place her in a skilled nursing facility. She had saved her money, so it was private pay. The third month, I noticed the bill went down. I found that odd because I knew there had been no reduction in the level of care she needed. If anything, it had increased. I was told that the state mandated a surcharge on all private pay patients during their first sixty days in order to make up for the low reimbursement rate on Medicaid patients. In other words, there as an indirect tax being charged by the home as an agent of the state. Otherwise, the home could not afford to keep Medicaid patients.

    Imagine what we would all be paying for cars if only corporate fleet managers were allowed to negotiate with dealers? That’s the way pricing works in many areas of medicine.

As it turns out, the Affordable Care Act is not exactly affordable after all.

Isn’t there some kind of “truth in advertising” law under which the authors and namers of this crap-fest can be prosecuted?

When Obamacare finally kicked in two years ago, I enrolled in a Blue Cross Blue Shield silver PPO plan from the Obamacare exchange. Yes, it was somewhat expensive, but it was still a decent plan with decent benefits, and I could pretty much go to any specialist I wanted without a referral, and go to out of network doctors. Well, a few weeks ago I got a letter that not only is my PPO plan being canceled, but Blue Cross Blue Shield is canceling ALL individual PPO plans in Texas, and my only option is a lousy HMO plan, of which network my doctor is NOT a part of. So much for “if you like your plan, you can keep your plan”. Hell, you can’t keep your Obamacare plan if you like apparently!

Literally every prediction on how it would fail has come to pass.

Plus, no one imagined just how much of an unmitigated disaster the roll-out would be, and really still is – given an unlimited budget and years to work on it. How hard is it to build a website?

I never expected a single one of my liberal friends (and most of them are just that) to apologize, or even acknowledge that I was right. What’s shocking is that they ALL still think Obamacare is just wonderful and fulfills all of its promises.

The closest I ever get to admission of its failures is when someone claims that Obamacare isn’t really what they wanted anyway, that they really wanted Single-Payer (the Communist, rather than the Fascist, policy solution) – usually followed by the bogus claim that they had to do Obamacare instead because D’s had to compromise with R’s. As if they were unaware of the fact that zero R’s supported the bill, D’s had the votes to pass it themselves once they went the reconciliation route, and D’s could have implemented anything they wanted.

When they said affordable they meant affordable to the insurance companies that wrote the law. Mr I won’t have a single lobbyist in my administration was kidding. Didn’t you realize that?