Are the past due medical bills piling while annoyingly fighting on the phone with the health insurance company about medical coverage? Do you have a strategy or plan to pay the hospital or private physicians for services rendered? Are all these incessant thoughts affecting your relationships and you feel there is no way out of this rut? Welcome to the world of “affordable” insurance, where it has been really affordable for insurance companies to provide low premiums in exchange for high deductibles. These affordable plans are sufficient for the healthy person until life throws the curve ball and the shocking sticker price makes one cringe. The savings at the front end may wither once the realization that deductibles have to be met. Looking to switch to another insurance plan may not be the solution as premiums increase while deductibles decrease, but the loopholes leave wiggle room to pass on the cost-sharing from the health insurance company to the consumer.
The Affordable Care Act was intended to expand coverage and provide medical access to all through subsidies for eligible participants. However, one would be gullible to think that an ineligible participant is any worse off than the eligible participant. The difference between the two types of participants is the subsidies for the premiums allotted to eligible participants, but the deductible remain the same for both participants. The metal level chosen will determine the deductible cap. For instance, the premiums for a bronze plan will be dependent on the individual/ family’s income but the deductibles can reach as high as $3500 annually before the insurance begins to cover the cost. Patients and physicians have reported that insurance companies work out deals with medical facilities to keep patients in the deductible zone as long as possible so not to pay for bills exceeding the out-of-pocket maximum.
Additionally, Americans are told in every election cycle that Middle-Class America will be the campaign’s focus, yet nothing is done to alleviate the high cost of living bearing down on Middle-Class America. The advantages of the Affordable Care Act was to extend Medicaid eligibility to more participants and to subsidize participants earning less than 400% of the Federal Poverty Level. A Middle-Class American family of four earning over $90,000 will not receive a health insurance subsidy, no matter how high expenses may get. To clarify, a couple earning $150,000 with expenditures of a car lease, nanny, student loans, insurance, utility bills, food and etc., will not live the American dream of buying a house in suburbia or have a proper financial retirement savings account. The less fortunate will be covered through Medicaid while the low-end Middle-Class American family will have subsidies for the insurance premiums and the rich can afford the premiums. How does the Affordable Care Act benefit a Middle-Class American family? Another question posed is, who benefitted from the passage of this legislation?
Oddly enough, the Federal Government and Unions fought for an exemption status for their personnel from the passage of the Affordable Care Act. The American Association of Retired Persons, the insurance company that fought for the Affordable Care Act claimed the grandfather clause as a means of not covering certain medical claims. States maintained their right of exclusion from the health care exchanges discounting the fact they were promised large sums of money to participate in the exchanges but declined because of future expenses related to the program. The Affordable Care Act mandate on small businesses providing health coverage was not implemented on the designated date due to kinks within the program. The pushback from Americans is still fierce as many families are feeling the unaffordability and nuisance of the Affordable Care Act.
We are constantly told of the increased cost for medical services rendered, to justify an annual 20-50% increase in premiums. Insurance companies are feeling the pinch that some insurance divisions are closing down due to increased cost of business and decreased stock valuation. The savings that were promised through the passage of the Affordable Care Act are nil, due to the multitude of mandates increasing cost which were passed onto the consumer. Year after year private insurance companies follow the Medicare and Medicaid trend of reducing physician reimbursement, yet cost-sharing increases for the medical services rendered. For instance, a pediatric patient visiting the physician’s office for wheezing will pay a copay for the visit and any procedure done, unlike in the past most insurances required copays only for the visit.
Is the Affordable Care Act a win some lose some situation? Middle-Class Americans suffer the most as they do not have either the full support of the government nor the means to afford the increased cost of living. This is not a call for universal healthcare, rather an admission for the failed healthcare policies that were supported by the mass. We believed in empty words because of the embellishment of a simple life we all strive for, called the American Dream.