Health Milestones After You Quit:
Earth Wind Fire Water
Athirapally Falls, truly the Niagra of India
We lost Aldous Huxley 50 years ago today – remmeber him wiht some gorgeous vintage and modern illustrations from his only, little-known children’s book
I feel an irrepressible urge to add my Texas-flavored, layman’s two cents in trying to clarify some current questions being raised about ACA (Obamacare):
So who are the people seeing negative effects of ACA?
About 80% of all people get group insurance through work, are old enough to be on Medicare, or are on state Medicaid due to low-income/assets. Of the remaining 20%, 15% are folks who do not have insurance because they are in part-time work, too “wealthy” for Medicaid, or underemployed/unemployed will all now have access to private insurance for the first time through the ACA Marketplaces (aka Obamacare website).
In Texas this is even worse since, a quarter (25%) of the population, about 6.3 million people do not have insurance. The marketplace will be really great boon here. For example, in my area (Carrollton, Denton County) there are 36 different private plans which include PPO & HMO plans: cheap Catastrophic ones, Bronze (covers 60% of costs), Silver (70%), Gold (80%) and Platinum (Cadillac baby!).
That leaves about 5% (14-15 million) of Americans who buy their own individual insurance who are normally very responsible self-employed or small business people. This is the group that may be adversely affected because insurance companies have chosen to change their plans using the ACA as an excuse. The insurance companies are in it for profit and want to offer better plans and keep their customers after all.
So what’s up with all these dropped polices?
For a little background consider that back in March 2010, ACA regulations were written to “grandfather” all individual insurance plans even if they weren’t comprehensive enough or didn’t adhere to ACA’s 10 Essential Benefits as long as they did not substantially change their plans and offered continuous coverage to the insured. This was the famous promise made by Obama.
FYI, the 10 Essential Benefits of ACA required for “Obamacare” plans are:
Individual insurance plans that were not “grandfathered” (i.e. offered after March 2010), or “grandfathered” plans which have changed, have to comply with above requirements starting in January 2014. The folks who are receiving these infamous “cancellation” letters are being subject to the whims of the insurer which may have nothing to do with ACA, since the provisions don’t kick in until next year.
Now some of these individually insured people are being asked to change their plan to an ACA-compliant plan starting next year and the new premiums offered seem to be much higher. These folks may actually see lower premiums for better coverage on the ACA Marketplace driven by the subsidy (money) being offered. They should shop there as soon as they are able so they will have benefits next year.
So what did our great State of Texas do?
Not a great story here although I’m proud to be living here. Our leaders, in their wisdom, chose not to create a Healthcare Marketplace and kicked it upstairs. So people like me have to go the Federal ACA Marketplace to shop for private insurance.
Leaders also chose not to expand Medicaid for people that would fall through the cracks because of the premium expense even though we are Uninsured Central with 6.3 million who don’t have anything (Including a million kids). Uninsured people don’t get shots for their kids, don’t get to make office visits or can’t schedule procedures. Instead when the condition has progressed to an intolerable level they may go the ER and get rather heavy-duty, expensive treatment, the costs of which are borne by premium paying people. The most glaring fact here is that the Feds were going to pick up entire tab of this for 3 years and pay 90%+ for 2 more. Shortsighted indeed! The reason given is - what was Texas supposed to do after 5 years? IMO most people who have to get Medicaid are not proud of that fact and would rather make more money and control their own destiny in the private insurance market. I know I would in those shoes.
So, I wouldn’t applaud Texas just yet.
So where do we go from here?
The 80% of the folks who are in group insurance already enjoy the benefits of ACA (true for the past 2+ years) in terms of enhanced coverage, free preventative care, no impact from pre-existing conditions and the ability to keep kids (26 and under) on their plans. Goodness!
The 5% in the individual market (discussed in previous section) are either grandfathered or getting “cancelled” but IMO many in this group will be able to get better and more durable plans from the ACA Marketplace with lower or breakeven premium costs. Some will have to pay higher premiums even on the Marketplace if they want decent coverage. Could be good for many!
Now for the 15% uninsured (25% in Texas) the ACA tried to roll out the Marketplace with private plans and subsidies based on income-level. As we all know this rollout of the “website” has been an unmitigated disaster (a royal cluster fuck IMO) and almost left me at speechless (well, not really), especially since I have a technology background. I believe HHS will fix it and we will be able to move ahead, albeit a little behind schedule. Stay tuned!
In this age of instant analysis, instant gratification and a 24-hour immersive news cycle we could see this as an epic fail of ACA (Obamacare y’all) but this set of insurance reforms affects 6% of GDP and is highly complex with many moving parts that will take time to tweak and get right.
ACA is a long play and we need judge it in the long horizon – 4-5 years out. I know there’s a lot bad news out there now but the good news needs to be cherished as well. Check out a sample testimonial: http://t.co/7i5uX3enE0
I’m optimistic and just want to say: May the Force be with Obama and the United States of America.