The affordable care act is still in force and now the President is making some changes to supposedly give more access to Americans. The change is that starting on 2/15/21 until 5/15/21 anyone who does not have coverage can apply and get covered. While this is an improvement for the ACA by now allowing those that missed the cutoff to obtain coverage, the real issue is never discussed. Why is there only one time a year that you can sign up for coverage? I think I know the answer which is if you could sign up at any time most people would wait until there was a medical necessity to buy insurance. The insurance companies do not want that, so the government agreed to specific timeframes to buy coverage. Of course, I am only discussing the annual election period and not the special election periods when a person has a qualifying event that allows them to purchase coverage within 63 days of that qualifying event. Typically, a qualifying event means loss of current coverage, moving out of the current service area, marriage, birth, divorce, or death.
Part of that problem is the cost keeps going up with no end in sight. Premiums vary across the country but here in Nevada the premiums keep rising and so do the deductibles and maximum out of pocket. Most Nevadans end up with a high deductible plan because the cost is lower, and they cannot afford a lower deductible plan. Today, most premiums are like having a second mortgage, they are so high.
When the ACA was first introduced by President Obama, he made some very bold statements that over time have proven to be untrue. He said the cost would be lower than with previous coverage and he said you could keep your doctor. Neither of those items we true and today it is even more unaffordable.
The coverage you can afford is usually a very high deductible plan that only pays after the deductible has been met. To meet that deductible, you almost always must be hospitalized because those deductibles are very high. Most Americans cannot afford to pay the deductible and to meet it and pay for it requires loans from family or bank loans, or if you have the money by taking it out of savings. According to recent information the average American cannot afford to pay more than $400 for an emergency. Those charges are in the thousands, not hundreds. Along with higher monthly premiums even for the very high deductibles plans, the plan will not pay until the deductible is met. Those that take expensive medications are also left out, so those expensive medications are paid in cash. I always advise my clients to find other ways to pay for those medications. Sometimes the pharmaceutical manufacturer offers lower prices to those that cannot afford the medication. You must earn less than their maximum income to get those discounts. Those that make more end up paying the list price for those medications and it is not inexpensive. Of course, there are other ways like the big three in discount medications: Good RX, Singlecare, and Nevada Drug Card. Also include both COSTCO and Wal-Mart and pay cash for your medications.
Many doctors refuse to accept these insurance companies simply because those companies pay very little to the doctor. Sometimes these companies use the Medicare model of payment which is even lower. The doctors are caught in the middle between the insurance company and their client. Not good for anyone.
There really is no acceptable solution other than to move towards a national plan which I am not in favor of doing. Simply put, when has the government ever done anything that is not losing money. Look at social security, Medicare, or any other government program and show me they are not losing money. A national policy or government-controlled healthcare will cause many doctors to leave medicine, leading to a greater shortage of doctors and many hospitals will close because the payments will be less than they are getting now and will cause many to close their doors.
Of course, one of the issues never discussed is why is Congress allowed to have their own plans which we pay for and those plans are better than those bought through the affordable care act? If Congress is not part of the problem, there will never be a solution that works. We need to force Congress to be on the affordable care act because if they are, they will see how bad it really is and maybe fix it? That is what is needed to make changes in the affordable care act to help Americans.
The Barend Agency Inc
Len Barend, broker