Will Obamacare Solve The Problems Of The Underinsured?


In 2009 I followed the progress of Health Care Reform quite closely.  One could even say I allowed myself to become obsessed by it.  If C-Span was not showing a congressional committee meeting on the topic so I could see what was happening myself, I was reading someone else’s speculations.

I’m certain that if Nancy Pelosi had not forced a vote when she did, my friends and family would soon host an intervention for me.

I really should have lived by the advice that was sung so beautifully by the late Doris Day, Que Sera Sera (Whatever Will Be Will Be).

After more than a year of public debate, when it was clear that an overhaul of the nation’s health insurance system would be divisive, the Patients Protection and Affordable Care Act was written by 6 men behind closed doors.

Although we had been promised “transparency in government” by candidate Obama, when it became clear that he could not get his way if things were made known to Americans, Obamacare was written in secret.

Harry Reid then required the Senate to vote on the 2700 pages of the bill within 48 hours of allowing 100 senators to read the document.  (With all the requirements that occupy a senator’s time, I wonder how many of the 100 actually read what they were voting on.  Since the final vote was on party lines, I suspect that the senators did not read the bill and voted as their leaders told them.)

When it became clear, the following year, that members of the House were not going to get an overhaul of the insurance industry passed, Nancy Pelosi and Barack Obama forced a vote on the bill that had already gone through the Senate.  It passed by 2 votes.  (In my opinion, it was far from being a popular law.)

On March 23, 2010 the Patients Protection and Affordable Care Act, (also known as Obamacare) became law.  Finally, the uninsured and underinsured had hope that what they had worked for their entire life would not be taken from them if they got sick.  Or did they?

UNINSURED

During the Health Care Reform debates of 2009 I kept hearing about the plight of the millions of uninsured Americans.

Ironically, even though I am an insurance agent and pay very close attention to it, I did not see one instance of one of the millionaire politicians paying for health insurance for someone else out of his own pocket.

The PPACA attempted some relief for the problem right away.  It required health insurance companies to cover children regardless of their health history and allowed young adults to remain on their parent’s health insurance policy through age 25 whether or not they were students.

The PPACA also authorized a High Risk Pool for uninsured adults.  The pool would provide health insurance for adults who were too sick to qualify for health insurance from private companies.  Unfortunately, it had two problems.

  1. It required one to remain uninsured for 6 months before it would cover one’s medical bills.
  2. It ran low of money after less than 3 years.  In March, 2013 Mr. Obama directed that in order for the government to pay expected claims for those who were already in the program, no new policyholders would be accepted.

The majority of those who had not health insurance would need to wait for 3 years (after the presidential election) to be covered.

UNDERINSURED

During the Health Care Reform debates I heard much talk about the millions of Americans who had Limited Benefit plans and others who experienced problems when they were sick.

Since the bill was signed into law, I have not heard anything about the underinsured.

Some people can only afford health insurance to pay for routine medical care.  They are covered if they get the sniffles and need a prescription so they can go back to work.  However, they are at tremendous risk if they suffer a major illness or accident.

Others are a little better off.  They can afford a policy to protect them from huge medical bills if they suffer a major illness or accident.  However, they are on their own for routine health care.  If they get sick and need to see their doctor in order to get a prescription so they can return to work, they must absorb both the doctor’s office fee and the bill at the pharmacy.

A routine case of strep-throat could cost someone with a catastrophic policy several hundreds of dollars in doctor’s fee, lab charges and pharmacy bills.  It is probably not enough to justify bankruptcy proceedings but it is enough to cause most people to think twice about seeking medical help before a routine ailment turns into a catastrophic event.

WAIT AND SEE

We Americans, including us skeptics, were promised that if only we accepted the PPACA the problems of the uninsured and underinsured would be solved.  The PPACA has been the law of the land for over 3 years and I have still not seen much progress.

Yesterday I read, “Uninsured Population Swells In Advance Of U. S. Health Law.”

The first paragraph reads, “Almost half of working-age adults in the U.S. had inadequate health insurance or no coverage at all last year, a widening deficit that the Affordable Care Act should mitigate, according to data from the Commonwealth Fund.”

My first thought is, “Although the politicians who drafted the PPACA may have had good intentions, they have apparently failed.”

Since the PPACA was approved in 2010 the trend line has gone the opposite direction from what was intended.  If we accepted the PPACA our nation was supposed to have fewer uninsured and underinsured.

I am told to just wait for the Essential Benefit Plans and the new health insurance Exchanges.  According to Obamacare supporters, they will solve all the problems.

Maybe they will solve the problems of the uninsured but not the underinsured.  None of the Essential Benefit Plans offer 100% coverage.  By definition, Americans will be underinsured unless they have sufficient money in their Rainy Day fund or have a supplement to pay for what their Essential Benefit Plan does not.

When it is all said, the only way to be certain that Obamacare has been successful is to wait and see.  With any luck, the days of Americans having to choose between health care and affordability are over.  However, I still remain skeptical.

In yesterday’s post, “How To Prevent Bankruptcy Because Of Medical Bills,” I outlined a strategy that you can use if you are concerned that the Essential Benefit Plans are going to leave you too exposed to serious illnesses.

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