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755Huffington Post demonstrates once again how the media just does not get it when it comes to explaining the Affordable Care Act

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  • Jerry Policoff
    Sep 20, 2013
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      Few would argue that the Affordable Care Act has no good provisions, and that there are not some, perhaps many, who will benefit from it, but that is not universally true, and perhaps not even true for the majority of Americans who may gain insurance coverage but remain unable to afford actual health care.  The down sides of the ACA are being virtually ignored by the Obama Administration, and the media has displayed an abysmal ignorance of the Act and an unwillingness to educate the public about it.

       

      The article below could have been written in a manner that explained some of the down-sides of the Affordable Care Act.  Instead it leaves out pertinent details and leaves the likely false impression that the ACA is going to seriously lower the cost of healthcare for the typical American.

       

      Example one in the article revolves around 56-year old Bonnie O’Brien who earns $62,000 per year and has health insurance through her employer who subsidizes the cost.  The article suggests that Ms. O’Brien might be able to do better with a “silver” plan in the Exchanges that would cover her and her son for an “estimated” cost of $491 per month.  The use of the word “estimate” is not explained, but all of the current costs being published for Exchanges depend upon how closely the actual participants who enroll in the Exchanges mirror demographic projections.  For example failure to attract enough young enrollees could significantly and negatively impact the monthly premiums. The article explicitly states that Ms. O’Brien would qualify for a $48 per month tax credit if she switched to the Exchanges, but in fact, the ACA specifically denies subsidies to people who are currently enrolled in employer-provided health plans except in very limited circumstances that do not seem to apply to Ms. O’Brien.  In other words, in the case of Ms. O’Brien, the author is understating her projected monthly premiums by $48 per month, raising them to $537 per month if she switched, not $491.  This is just sloppy and misleading journalism.

      The author does cite some doubts voiced by Ms. O’Brien: "I would have to have the variables, what this includes versus what I've got," she said.  Those are wise misgivings expressed by Ms. O’Brien, but the author seems to marginalize them rather than examine them.  Simply comparing premium costs to what one is currently paying for insurance is an apples to oranges comparison (as Trudy Lieberman has repeatedly emphasized in her media critiques in the Columbia Journalism Review).  Just as important is what is covered and how do the deductibles and co-pays compare.  Washington State Silver plans will typically carry a $3,000 deductible with a 30% co-pay once that number is reached.  Thus Ms. O’Brien’s first $3,000 in medical expenses would be out-of-pocket in the Exchange as would be $30 out of every $100 billed thereafter until the out-of-pocket limit (which excludes insurance premiums) is reached. In her case that would appear to somewhere in the $16,000 per year range in out-of-pocket premiums and medical costs or nearly 30% of her net pre-tax income. Chances are that the $600 + Ms. O’Brien now pays for employer-provided health insurance carries lower deductibles and co-pays and offers better  coverage (as is often the case with employer-provided health plans), and that switching to the Exchanges might be a bad decision for her, but you’d never know it from reading this article.  Clearly the author is off-base in concluding that “it's Americans like O'Brian -- older but not yet senior citizens and eligible for Medicare -- who might stand to gain the most from the law.”  It appears more likely that the reverse would be true for Ms. O’Brien even though her monthly premiums under an ACA Silver plan might be marginally lower than what she is paying now (and even that is not certain).

      Applying this same situation if Ms. Obrien was currently uninsured, her annual premiums in the Exchange with a Silver plan would be $5,892 with potential additional out-of-pocket medical costs of about $12,000 for her and her son.  Again, in most cases government subsidies and tax credits apply only to premiums, not medical bills (and medical cost deductions on Federal tax returns have been sharply reduced this year).  Paying those medical bills on top of monthly premiums will be a major challenge for millions who enroll in them.  Under the Bronze plans the coverage will be similar to the Silver with higher deductibles and co-pays (40% after the deductibles are met versus 30% in the Silver plans) and somewhat lower monthly premiums.  The author of this piece fails to point any of this out. Being insured but lacking the resources to pay medical bills often results in avoiding going to the doctor or in failure to fill often costly prescriptions.  This is called being “underinsured,” and it is not all that different from being uninsured except that the uninsured are not saddled with those monthly premiums.

      Next the author presents the case of Tom Lloyd, an uninsured cabinet designer who stopped looking for insurance in 1998 when he was quoted $9,000 per year in premiums with a $5,000 deductible. He suffers from numerous pre-existing conditions. He can afford to pay his medical bills but worries that this may change if he gets seriously ill or suffers a major injury.  He expects to earn $66,000 this year. 

      The author writes that Mr. Lloyd can  purchase a silver plan in California for $599 per month (this time failing to mention that this is an estimate and that it is far from set in stone).  The author writes that this is a “a little less than Lloyd spends out of pocket for health care each month now.”   California provides Exchange cost limits that are more generous than most states (good for Mr. Lloyd, but not particularly helpful for those unfortunate enough to live in the other 49 states.  Even here though, the author implies that Mr. Lloyd will pay less for coverage under the ACA than he now pays out-of-pocket for his medical bills.  That seems unlikely because California Silver plans carry a $2,000 deductible plus $45 per doctor visit co-pay plus an additional $500 deductible for medications. Assuming he visits a doctor only once a month, and assuming faulty enrollment projections do not increase the cost of those monthly premiums, Mr. Lloyd is looking at an additional $3,000 per year in out-of-pocket costs.  This would increase his total healthcare costs over and above the $599 premium (which is only slightly below his current medical-related cost) by more than $3,000,  a 40% + increase in out-of-pocket cost a year to over $10,000 per year to  more than 15% of his net pre-tax income.  As mentioned earlier, his tax deduction for medical expenses is also going to decline effective this year resulting in a higher tax bill.

      The author of this piece quotes Mr. Lloyd: "I'm chomping at the bit here for October to come through so I can start looking at these exchanges," he said. "This is a deal of a lifetime for me."

      Is it really?  The reality would seem to suggest that Mr. Lloyd’s medical expenses are going to rise substantially under Obamacare, but one would never know it from reading Mr. Young’s article in the Huffington Post.

       

      jeffrey.young@...

       

      Some Of Obamacare's Biggest Winners Know Little About The Law

      Posted: 09/20/2013 7:41 am EDT

       

      obamacare pre-existing conditions

      Health Insurance, Health Care, Health Care Reform, Obamacare Older Americans, Obamacare Pre-Existing Conditions, Aarp Obamacare, Jeffrey Young on Health Care, Obamacare, Obamacare Aarp, Pre-Existing Conditions, Uninsured, Business News

      Bonnie O'Brian faced a rude awakening just after her 55th birthday last May: Her insurance premium soared 38 percent to $611 per month.

      O'Brian was told by her insurance company that she'd reached a milestone, the age where her rates would jump up much more than those of younger people enrolled in the same health plan.

      "I was like, 'Well, happy birthday to me,'" said O'Brian, who lives outside Seattle in Renton, Wash., and has been buying her own insurance for more than a decade. "If this is what 55 feels like, what is going to happen in the next 10 years?"

      If President Barack Obama's health care reform law lives up to its promises, O'Brian's insurance picture could brighten considerably in the coming decade.

      Now 56, O'Brian makes $62,000 a year doing marketing and communications work for an attorneys' association that helps pay for her health insurance. Under Obamacare, O'Brian and her 22-year-old unemployed son could both get covered by a so-called silver plan designed to cover 70 percent of their medical expenses for $491 a month, according to an estimate from her state's health insurance exchange. That includes a $48 discount because their household income qualifies them for tax credits.

      Still, O'Brian isn't that excited about Obamacare yet. Like many Americans, she feels doesn't understand the health care law well enough to know if it will make things better. "I would have to have the variables, what this includes versus what I've got," she said.

      Though much of the conversation around Obamacare has focused on the law's impact on young adults, it's Americans like O'Brian -- older but not yet senior citizens and eligible for Medicare -- who might stand to gain the most from the law.

      The current health insurance market in most states can be downright inhospitable for older Americans. Since insurance companies don't profit by paying medical claims, they often seek to sign up the most healthy people and keep out those likely to rack up big medical bills.

      New Obamacare rules will do away with a lot of the barriers older people face in gaining and keeping health coverage. Under the law, health insurers are prohibited from turning down anyone, regardless of their health or medical history -- and they can't charge them more than healthier people. Older people can't be made to pay any more than three times what younger people pay and women won't see higher prices than men.

      This marks a stark change from the way things typically work today. Under current law in most states, health insurance companies are free to reject applications and charge sky-high rates to people who are older or who have chronic health conditions or so-called pre-existing conditions. Insurers can make older people pay five times or more compared to younger customers. Health insurers also can sell people plans that cover everything but the health conditions for which patients will most likely need care.

      "I don't want to call it the Wild West but it was a challenging situation to try to figure out, to try to pay for -- and that's if you could qualify," said Nicole Duritz, vice president for health education and outreach for the Washington, D.C.-based AARP, a membership and advocacy organization for people over 50.

      Middle-aged people are especially at risk, Duritz said. "When you get into your 50s, you in all likelihood have some pre-existing conditions."

      And health insurance companies can broadly define those conditions, Duritz said. "It could be that when you were in high school -- this is my husband -- you had a knee injury. That's a pre-existing condition. It could be that you went in and had acne treatment and that can be a pre-existing condition," she said.

      As many as 129 million Americans have something in their medical history that could qualify as a pre-existing condition, the Department of Health and Human Services estimated in 2011. Yet many of these adults so far haven't received adequate information about the changes to come under Obamacare.

      Nationally and through its network of state affiliates and partnerships with patient advocacy groups, the AARP is trying to get the word out to the over-50 set. Duritz expects the Obama administration will devote a portion of its outreach and advertising to attracting older people and people with pre-existing conditions to the new Obamacare health insurance exchanges during their enrollment period, which runs from October through March.

      "The folks who have been left out in the cold, they're eager for this. I really believe that. So they're seeking this information out," Duritz said. "They're already thinking about their health coverage in a way that's very different than a younger person thinks about it."

      Tom Lloyd, 59, is one of the 14 percent of Americans between the ages of 55 and 64 who was uninsured last year. Lloyd, a cabinet designer who works as an independent contractor in Culver City, Calif., near Los Angeles, hasn't had health insurance for more than 15 years.

      The last time he even tried to shop for health insurance was in 1998, when a company offered to sell him a plan with a $5,000 annual deductible for about $750 a month.

      "I got the sticker shock with $9,000 a year and I thought to myself, 'Well, there's really no way I can afford that. I just don't make that kind of money,'" said Lloyd, who expects to earn about $66,000 this year.

      Lloyd has several chronic medical conditions, including diabetes, depression and anxiety, that require regular doctor's visits, prescription drugs and medical supplies. The diabetes diagnosis in 2010 made him feel even less likely to find affordable health insurance, he said.

      While he can pay his monthly medical expenses, Lloyd worries a serious illness or injury could wipe him out, as it could anyone who is uninsured, he said. "There are millions of other people that are just like me, that are just one accident away from losing everything," he said.

      A bout with pancreatitis and resulting complications landed Lloyd in the hospital twice six years ago -- and resulted in a $36,000 bill, giving him a glimpse of his insecurity, although the hospital soon went bankrupt and he's never been called on to pay the debt.

      "It's just too terrifying to think that you're just one step away from having somebody take the house, or be in the poorhouse," Lloyd said. "Sometimes it's just better not to think about it. It's the only way you can get through the day. If you start thinking about it, you end up in the fetal position underneath your desk."

      Lloyd is hopeful he'll find coverage on the health insurance exchange in his home state, dubbed Covered California, that he can afford and that will protect him against a financial catastrophe.

      According to a premiums calculator provided by Covered California, Lloyd could purchase silver level coverage for $599 a month, though his income is too high to qualify him for a tax-credit subsidy. Silver plans are the second-least generous of the four "metal" levels of coverage -- bronze, silver, gold and platinum -- available on the exchanges from various insurance companies.

      That's a lower price than he was quoted in 1998, and it amounts to a little less than Lloyd spends out of pocket for health care each month now, he said.

      "I'm chomping at the bit here for October to come through so I can start looking at these exchanges," he said. "This is a deal of a lifetime for me."

      http://www.huffingtonpost.com/2013/09/20/obamacare-pre-existing-conditions_n_3943611.html

       

       

      Jerry Policoff

       

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