Do You Know The Whole Truth About Obamacare In 2014?


Bronze Paulus of Tiziano Aspetti 3D
Bronze Paulus of Tiziano Aspetti 3D (Photo credit: wim hoppenbrouwers)

I have a B.A. in Bible with minors in Theater Arts and Psychology.  When I was deciding if I should go to graduate school, I counseled with one of my professors.  Dr. Afman told me that as long as I knew where to go to research the answers to my questions, I did not need to spend 3 more years in Seminary.

Another professor told me that the Ph. D. degree is highly over-rated.   According to him, if I read for 30 minutes a day on the same topic for 10 years, I would have just as much knowledge as a Ph. D.

Based on their advise (and the cost of 3 more years in school) I elected against spending more time in academia.  I graduated in 1982 and except for a couple of boughts with nostalgia, never looked back.  I do not regret not spending 3 more years in school.

My goal was to be a pastor but after 6 years of that, my career path changed.  My vocation may have changed but not my core beliefs and knowledge.  Today, I still apply the wisdom that was given to me over 30 years ago.

When I am not working with customers during business hours, I am trying to educate myself.  The difference is that I no longer view a person with a Ph. D. as superior.  I have learned that in most cases what matters is not what happens in the classroom or office.  What really matters to my clients is what happens in the living room and at the kitchen table.

When I meet with someone they are not interested in speculation or political spin.  My clients are interested in the truth of what is going on with their health insurance.

Over the past 4 years there has been a complete over-haul of the health insurance system in the United States.  Long standing truths from 2009 have been replaced with new laws, rules and regulations.

Obamacare has already made some major changes to health insurance, however, the biggest changes are yet to come.  I work with people who own their own business or work for a company that does not provide health insurance.  When my clients ask me questions about health insurance, they do not want spin and excuses.  They want facts on which they can base informed decisions.

In this post I want to discuss a couple of the major changes that are scheduled to happen in January, 2014.  Every American is aware that they are on the way.  Do  you know the bad as well as the good?

EXCHANGES

Section 5000A of The Patients Protection and Affordable Care Act mandates that every American purchase an “Essential Benefits” health insurance plan unless they are specifically exempted.

If you are on Medicare, Medicaid or get your health insurance through your employer you have nothing about which to be concerned.  If, however, you have no health insurance, are self-employed or your employer does not offer health insurance, you will need to get your own health insurance.

The PPACA requires each state to build an on-line market place from which citizens can purchase one of 4 different government “Essential Benefit” plans if they do not wish to use an insurance agent.

These on-line market places are called “Exchanges.”  The PPACA anticipated that not all states would want to spend the money required to establish their own exchange.  It allows the Department of Health and Human Services to run a federal exchange when the state refuses to establish their own.

On the surface that sounds like a fairly easy issue with which the Department of HHS can deal.  The problem lies under the surface.

Each state has different laws and mandates regarding health insurance.  Unless HHS is willing to ignore state laws, it will need to build a separate exchange for each state.

As of today, more than half of the states are not prepared with exchanges.  That means that HHS would have to build a different exchange for each of them.  Although HHS is on record saying that they are on schedule to roll out the new exchanges for Americans to enroll in government approved plans in October of next year, there is a good chance that everything could be delayed for a year while HHS plays catch-up.

The track record for the current edition of HHS to implement the mandates of Obamacare is not stellar.  The Secretary of HHS has ignored or delayed implementing almost 25% of what she was instructed to do by congress in the PPACA.

SUBSIDIES

Much has been said about the subsidies that will be given by the federal government to help people purchase their “Essential Benefit” plans.  The Obamacare subsidies give many people the “warm fuzzies.”

What is not being said is that the subsidies are based on the philosophy of, “Something is better than nothing.”  The subsidies will be calculated on the price of the “Bronze” plan.

The “Bronze” plan is the least expensive plan that will be approved.  It also has the least amount of coverage.  Currently, the majority of health insurance plans will pay 80% of medical bills.  The “Bronze” plan will only pay 60%.

It is true that millions of people who had not health insurance prior to Obamacare will get “free” insurance once the subsidies start.  It is also true that the “free” insurance will only pay for 60% of their medical bills.  They are responsible for the other 40%.

My concern is that if these people who are allegedly being helped could not afford to pay for health insurance in the first place, how are they going to be able to pay for the 40% of medical bills their “free” health insurance plan does not pay?  If the government is going to subsidize their health insurance, wouldn’t it make sense that they give them enough money to pay for health insurance that would pay all their medical bills?

I am also concerned about the character of the average American.  Many Americans do not like to be told by government what they must do.  The American Revolutionary War was caused by government mandates.

I am afraid that many Americans will only purchase the “Bronze” plan because it will be the least expensive.  If that happens, the person who currently is covered for 80% of his health care costs will only be covered for 60%.  The difference may be acceptable for routine health care but it can be quite expensive in the event of cancer, heart attack, stroke or other critical illness.

People who settle for the “Bronze” plan through the Exchange should also call an insurance agent to help them with a Critical Illness supplement.

Later this year you will be required to choose which health insurance plan you want for 2014.  When you make your final decision that the least expensive option will probably n0t be the best.  Take the time to consider what it does and does not cover.

Unless you h ave money set aside in savings that you are willing to give to your doctor, my guess is that you will want to consider either a better major medical plan, a supplemental insurance plan, or both.

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