Obamacare – a few reminders and successful anecdote

As I mentioned in earlier posts, Obamacare, while imperfect, complex and rolled out poorly, moves the ball forward in a major way to address our uninsured problem in the US. The website difficulties are being fixed, but it is important to remember a few things. Early implemented parts of the law have already extended coverage to 3 million young adults, eliminated the denial of coverage for pre-existing conditions on children (adults will get this on January 1,2014), eliminated lifetime maximum benefit limits, improved prescription drug benefits for seniors, restricted the profit margin on insurance premiums leading to policyholder rebates the last two summers to name a few key changes thus far. 

This law, which is largely a GOP idea, has been fought every step of the way with some GOP led states like my own in North Carolina not expanding Medicaid and offering state exchanges, both of which have led to increased premiums in the North Carolina version of the federal exchange markets and the former harming our impoverished citizens and state economy. For those who lost coverage like me (this is not news), if you make less than $111,000 as a family of five, e.g. (it varies by family size), you will also benefit from a subsidy on the exchange which will decrease your net premium. Note, a key reason for higher premiums for some is the elimination of the pre-existing limitation on coverage.

Enough about that, let’s use a real example, as this will be where the rubber hits the road. As noted above, my family is losing coverage under the individual market, but this is not a surprise, because my new insurance company told me this would happen when I signed up in May. I should add one of my adult children is losing coverage as well because we had to get a high risk pool policy, as he was denied by the insurance company because of a pre-existing condition. This denial will not happen under the new law, as noted above, which is a huge selling point.

So, I knew that our coverages would cease on December 31 and was waiting for the federal exchange options to be offered. With the new pricing structure to recognize the better benefits, the elimination of the pre-existing condition limitation, health care inflation and the impact of my state not expanding Medicaid which increased the cost in NC, because of my age I was one of the people looking at a premium increase for a slightly worse coverage plan without the subsidy. So, I shopped on the exchanges and here is what I can do, without a subsidy:

Keep slightly worse coverage levels with my current provider and $200 per month higher cost than both plans we have now for my son and everyone else;

-Obtain a similar plan through another insurance company with $55 per month less cost than we pay now;

– Obtain better coverage through another insurance company for about $160 per month more than my current plan, but less than the one offered by them above.

All of our doctors are in both networks, so that is not an issue, but this is very important in people’s decision-making. We will actually be doing the third option due to the better family coverage, although the second choice was tempting.

Now, again this is without the subsidy. So, with the subsidies shoppers will be seeing even lesser premiums than what is indicated above.  So, a few takeaways. If your coverage is ceased, don’t panic and look at the options that are available. If your family income is beneath 4 x the poverty limit ($111,000 for a family of five, $94,000 for a family of four, e.g.) then you will get an additional price break.

But, also note the following. If your state did not expand Medicaid, the cost of plans under the exchanges will be higher. If your state did not push a state based exchange, the competition is likely to be among fewer insurance companies, so the exchange cost options will tend to be higher. Obama deserves all the criticism he is getting on the poor rollout of the website and not being painstakingly thorough on what was going to happen. Yet, the GOP machinations are driving costs up as well with these two issues and not working to make this complex law better since election last fall, choosing to not support the education efforts and voting to repeal it over 40 times. I have been a broken record on this issue even before the election – make it better, not stand in its way.

People need to give the new law a chance and look at the options available. States that did not expand Medicaid need to strongly rethink this, as they are harming people and their state economies, so say the Rand Corporation and Kaiser Foundation. What was less noticed with the numbers announcement on exchange enrolments this week, was that 390,000 people have signed up for the Medicaid expansion in October.

But, all of this will be compromised if Obama’s team does not keep improving the website.

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6 thoughts on “Obamacare – a few reminders and successful anecdote

  1. Am to the point BTG that someone, even me, should shout out “Look People…this isn’t the end of the world as you think you know it. It’s rough going to be sure but WE WILL get it all straightened out. Do your part. Do your bit but Geez-Louise Get. A. Grip. Help us move this to where it should be…access to health care for everyone.” Tell me, what is so difficult about that?

    ….stepping down from soapbox…

    • Preach on. It is more to do with using this poor rollout and insurance cancellation as leverage. Given the track record on multiple issues – food stamps, healthcare, lack of Medicaid expansion, voter id, this faux concern and lack of culpability in the process – is very poor form.

  2. Finally, an analysis from someone I can trust! Thanks for the info. I am so sick of hearing the barely concealed glee with which some are celebrating the website problems as if they are not actively working to destroy Obmacare from top to bottom.

    • Thanks Amaya. The glee is pretty transparent and a shark in the water mindset. Someone told me today that she wished there had been this much energy to make it better with an eye toward helping people. There is a US Congressional committee sponsored Town Hall in Gastonia, NC on Friday with a leading title to glean all of the high premium, lost coverage stories. With a title like that, I am sure they will get the folks armed for bear rather than those who have been well served. Many of these folks who are armed for bear have likely not investigated the website (herein lies the big problem as the website could be the advertisement of the good parts of Obamacare when working) and seen the subsidies. I saw some numbers on BenefitsPro today, which showed much higher numbers of folks who have set up accounts and awaiting confirmation. The numbers were 1.1 million with 326,000 qualifying for subsidies, thus far. These numbers need further vetting. Thanks for the endorsement, BTG

    • Thanks. I am just hoping the website gets better. It is a journey right now – two steps forward, one step back. Unfortunately, when your biggest selling tool is balky, only the negative noise is getting noticed. Take care, BTG

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