Why Can’t I Wait Until I Am Sick To Buy Health Insurance?


Supplemental InsuranceIn the last few weeks, I have been asked the same question multiple times.  “What is to prevent me from doing without health insurance, paying the “penalty” and getting insurance only after I get sick or injured.”

I know there has been much political rhetoric about boycotting Obamacare for political reasons.  Unfortunately, the people who are advising others to boycott Obamacare do not offer practical advice on what to do if they suffer from an accident or illness.

Although I understand that it is human nature to not like being told what they have to do, I do not recommend people boycotting Obamacare for a few reasons.

EMERGENCY ROOM

One gentleman who asked this question painted a gory picture.  He asked, “What is to prevent me from doing without health insurance and going to the Emergency Room if I lose my arm in an accident and it is bleeding all over the place.”

I have been aware for years that people were thinking like this, but this was the first time someone actually asked me, “What if…”  I must admit, I was not prepared for that question.

For the past few weeks I have been unable to get that question, or that mental picture, out of my mind.  I had to study some areas of law to find out what would happen in that scenario.

I need to remind the reader that I am not a lawyer.  I am an insurance agent.  I only claim to be familiar with the law in a general way.  Before you break the law, and boycott Obamacare, I advise you consult with a lawyer.  Ask him/her “What if …”

You may have to pay your lawyer’s consulting fee, but regardless of how much they charge, it will be significantly less costly to you than developing cancer and having boycotted Obamacare.

The 1986 law, known as the Emergency Medical Treatment And Labor Act  (EMTALA) requires all hospitals who accept Medicare patients and have Emergency Rooms (ER) to assess and stabilize any person who presents with an “emergency” regardless of whether they have health insurance.

Section 1303 of the PPACA reads…

“Nothing in this Act shall be construed to relieve any health care provider from providing emergency services as required by State or Federal law, including section 1867 of the Social Security Act (popularly known as ‘‘EMTALA’’).

As I understand it, this would apply to a severed arm, like the gentleman asked.  However, although the ER would be required to stabilize him, they are not required to perform the surgery and follow-up treatment that such a trauma might require.

Unless he is independently wealthy and able to pay those health care bills himself, he will need the health insurance from Obamacare, regardless of his political persuasions.

HOSPITAL ADMISSION

Some people abuse hospitals.  They use them as mini-vacation spots where everyone is kind and pay special attention to you.

When I was growing up, it seemed that my mother was in the hospital every other year.  I know that some of them were for legitimate reasons.  I am convinced, however, that some of her hospital stays were so that she could get a vacation from us kids.

I know that it is tempting to view the hospital as a place to relax, however, it is very expensive.  If you need a vacation from the kids, find a hotel on the beach with a spa.  It can be just as relaxing and about 1/4 the cost.

Hospitals are places for sick people to get the health care they need.  They are not places for stressed parents to escape from their children.

Although EMTALA requires that hospital ERs assess and treat anyone who presents themselves at the ER, I am not able to find any federal law that requires hospitals to admit a person for health care treatment unless they can demonstrate the ability to pay.

Unless you are independently wealthy, you will do that with your health insurance ID card.

The people who will be most tempted to boycott Obamacare will be those people who have not needed health care for several years, live from paycheck to paycheck and see no reason to spend several hundreds of dollars each month to buy health insurance, “that we will never use.”

I concur with some of their thinking.  I would prefer to allow people to buy the health insurance they need rather than what the government tells them is necessary.  I see little logic behind requiring a single male, (non-drinker, non-smoker) to buy a health insurance policy that includes full maternity and substance abuse coverage.  He will never use them.  However, all Essential Benefit Plans must cover those risks as well.

Here is the problem behind boycotting Obamacare.  The future is uncertain.  Just because you have enjoyed good health in the past, there is no guarantee that trend will continue in the future.

You may have not needed a doctor since 1980 but that does not mean that you will not spend time in a hospital in 2013.   All it takes is one teenager texting and driving to involve you in a major car accident.

If that happens to you in 2013, you will be transferred to a qualified hospital ER to be stabilized but how are your recovery, follow-up visits and over night hospital stay bills going to be paid if you do not have health insurance?

You are still liable to pay your doctor and hospital.  Unless you are able to pay those bills out of your savings, you can expect collection calls for the next several years.  The only ways to make them stop is to pay your bill or file for bankruptcy protection.

MORAL

I honestly do understand the temptation to boycott Obamacare.  Like many others, I do not like to be told by government officials how I must spend my money.

However, I urge you to find some way to voice your displeasure other than opening yourself up to financial ruin.

The idea of waiting to see if something major happens and then getting health insurance is impractical.

You are only able to buy health insurance during the National Open Enrollment (Oct. 1, 2013 – Mar 31, 2014).  After March 31, 2014 you will not be able to buy health insurance unless you qualify for a Special Election Period.  (Most Special Election Periods are only available for people who have had prior health insurance in the last 63 days.  Boycotting Obamacare is not a legitimate reason for a Special Election Period)

Unless you have a Qualifying Health Plan by March 31, 2014, you must remain uninsured for the rest of the year.  If next summer a teenager is texting while driving and swerves into your lane, you will get treatment in your local hospital’s ER, but you may have problems with your hospital admissions, follow-up doctor visits, physical therapy, prescription drugs, etc.

There are ways for you to express your displeasure of Obamacare’s Individual Mandate other than boycotting the new Essential Benefit Plans and taking your chances.  I urge you to try one of them before you do something that could spell your financial ruin out of political zeal.

Alternatives 2

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