The mechanics of getting health care under the ACA are improving. The snake-oil salesmen to whom our life and health are handed after leaving Healthcare.gov, however, remain their slithering, slimy, selves. It begs the question: When do we remove the few hundred fiefdoms hijacking our most basic right to life, our health, and join the rest of the world's top industrial nations with real, affordable, universal, national health care for all of our citizens?
Last year, Republicans went volcanic over letters to constituents that told them that their non-ACA compliant plans would end. Republicans kind of, sort of well, neglected to mention that these insured would automatically, because of the ACA, be rolled over by their current insurer to the next closest plan that was ACA-compliant if they did not pick one of their own. They weren't being "dumped."
The Obama administration blinked, and let people keep bad plans that ripped them off, most of which you'd have to have a law degree to understand, in the fine print, how badly you were getting hosed.
You could hear a GOP pinhead drop this year. There was utter silence as my letter from Cigna arrived. My rate had jumped 78 percent in one year! My blood pressure spiked about the same level as my stomach dropped to the floor. I felt like the Grinch on Christmas Day: How could it be so?! I vented on Twitter, including @Cigna in my rage. Within a few hours I had a representative calling me to explain.
More on that in a moment...
Previously, on "Obamacare, the Game:"
In my first HuffPost Affordable Care Act (ACA) post, "Obamacare, the Game," I saved a little on the monthly premium, but a huge amount on a Gold plan for my blended family of seven.
In 2013, before the ACA fully kicked in, Blue Cross of Florida took my $2000 per person deductibles, lumped them all together, and hit me square between the eyes with a sky-high $14,000 deductible and $25,000 out of pocket for my family per year. The only good news was that Stephen King took an interest in the rights to my health care horror story.
My ACA-backed Cigna plan was a PPO, the plans with the most flexibility of seeing your doctor. It had a $0 deductible with $10,000 out of pocket, reasonable office visit, hospital and pharmacy costs, with a nice caveat that any one member of the family hitting $5,000 covered for out-of-pocket for the year was now "at cap." Given the other 63 plans that I waded through, this was the best balance of paying up front and paying out over the course of the year. I did not qualify for a government subsidy.
The ACA Works (Sort of)
How did I do under demon "Obamacare?" My health bills dropped by well over $6,000 last year, between slightly reduced monthly rates, and leaving the pre-ACA "you-pay" co-pay system with a deductible that could not be met unless there was a catastrophic health problem in the family.
2012's $2,200 urgent care trip for kid with the basketball court face-plant became the $70.00 urgent care trip for a same-sport, different kid in 2013. The pre-ACA $1,800 medicine bill at the allergist? $0 under the ACA.
I found out that I saved even more though. Roughly another $2,600.
The Osmond Family Plan & Shaking the 21+ Off the Family Tree
The very nice Cigna agent informed me that I saved more with the ACA than I thought. With seven in my family, Obamacare does not allow insurance companies to charge for more than the first three children in a household as long as they're under 21 years of age and living with you full time. My two younger children were receiving healthcare then, essentially, for free.
One of the most unpopular portions of the ACA, if you're an insurance company, has been the law's right to keep family members on the plan until they are 26 years old. Group pricing depresses what they can charge individual eighteen to twenty-somethings and nicks profits on plans that big insurers sell to colleges, most of which required health insurance even before the law passed.
At midnight of three 21st birthdays in our blended family, you could hear my insurance bill fattening up 76.4%. My two "free" kids became paid, and my three new young adults moved up a rate tier.
The barrel of the insurance company "gun" was pointed square at my head: Take the college plans and keep my good insurance, or move down in care and up in potential expenses to get a better price and keep everyone on the plan. Ultimately separating the twenty-somethings was the only sensible way to go.
I now pay for four plans, even though all of them are with the same insurance carrier, both at home and at school, for less than the one plan at the new, higher rate. It dropped my 78 percent rate spike to just 9.1 percent.
Just.
I share with you my story because it is emblematic of the level of complexity of the bloated private insurance-based ACA that is both inefficient and costly. It is a system whose "bottom line" focuses on corporate profits and executive compensation, not patient care, cost control, and improved outcomes.
You Betta Shop Around
I was told by a Healthcare.gov email to shop around for 2015, and not assume my plan was okay. There were HMOs, PPOs, and EPOs, all well explained by the Washington Post.
48 percent of the plans offered in Florida were Health Maintenance Organizations (HMOs), a bit ahead of the national average. Millions of Americans have to take these plans because they're often the most affordable. None of my doctors participate in them though.
21 percent were the sneaky Exclusive Provider Organization, an HMO/PPO hybrid which flat-out does not allow you to see a doctor outside of your provider network AT ALL other than in an often narrowly defined "emergency."
How's that a fail? Say someone goes to an EPO provider doctor and clinic for a routine colonoscopy which is "free" in the EPO plan. Well, sort of. The anesthesiologist doesn't happen to be in the EPO. You get their full $700.00 bill, and not even a negotiated discount from the insurer. It also doesn't count towards your deductibles or out of pocket.
Rates, terms, and conditions remain the achilles heel of the ACA. The private market has created, intentionally, a hodgepodge of rates, with hidden cost trap doors. You might save $1800 on the cost of a slightly different plan, but one trip in an ambulance, or even a few expensive medicines to take care of an eye problem or healing a broken bone could evaporate that discount and leave you $11,000 or more on the hook under deductibles and the out of pocket "cap."
Silver and Gold
The tiers "Platinum," "Gold" "Silver" and "Bronze" are virtually useless designations, at least on the federal exchange. There are Bronze plans that cost as much, if not more, than Gold ones, and Silver plans priced under Bronze. Offerings too, are the wild west. An PPO or EPO plan can offer better features on the Silver tier for less than a comparable HMO bronze plan.
New Year. Old Healthcare.gov Problems
The national exchange generally works. It remembered my 2014 contract, let me remove family members, and only failed once on showing me plans. A thirty minute hold for a specialist at Healthcare.gov, and I was told to delete the application and try again on Saturday morning, as the system was being swamped again with new applicants and it was overwhelming it.
It was my third call of the day, including two to Cigna, my current provider, to ask questions about plans and how to deal with minor problems in the ACA system, the Cigna system and between systems. I spent about four hours reading plans, and sorting things out, including the two-and-a-half hours to wait for advice over different phone calls to a local advisor, Cigna, and Healthcare.gov. Some of the personnel were well educated to the information and very helpful. Others, particularly at the government help line, were pretty clueless.
The private insurers are no more apt at dealing with insuring a lot of people either. Last year it took nearly eight weeks for Cigna in Florida to digest all of the new business coming from Healthcare.gov, issue account numbers and send out insurance cards. When I called this year to ask if I needed to pay the "deposit" of the first month on Healthcare.gov if I already had a Cigna account and wasn't changing plans, the operator really didn't know. They told me to pay the first month in the ACA system, and have the insurance company credit me if they double-bill me for it. Such efficiency and clarity!
Medicare for All
Single payer would make both the patient's and doctor's lives much simpler, improve care and reduce costs in the system. The Physicians for a National Health Program put it best:
"Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. As a result, administration consumes one-third (31 percent) of Americans' health dollars, most of which is waste."
Listening to endless background music at the different bureaucracies and help centers, I got one whose radio background was playing the appropriate Talking Heads tune "Road to Nowhere" which my bored brain gave a little health care-related spin...
"Well we know that we're growin'
And we know that we're agen'
And Healthcare.gov ain't goin'
So we can't see what what's the pla-an,
Yes we're not little children
And we want our good health,
But without single payer,
We just transfer dwind'ling wealth
We're on a road to health care
Come on sign-up
Takin' that ride to health care
Don't just give up.
I'm feelin' okay this mornin'
And you know,
Get hit by a bus and pay the price,
Down we go, down we go...
Getting everyone into the pool was a good first step. Costs are high and services on any plan are mediocre to poor at best unless spend huge amounts of your annual income for a "cadillac" plan. That was the case before Obamacare, and, while it has forced insurers, most of whose logos should be a skull-and-crossbones, to play a bit more "fairly" with consumers, we have a long way to go just to climb up to a standard of cost effective care enjoyed over much of the world today that is a bit wiser than we are.
My shiny two.