November 2012 Election News

Today I received an excellent summary of the implications of the 2012 election for healthcare in Colorado.  I highly recommend you mosey over and read the document.

My biggest concern in all the news and rumors about the Affordable Care Act is the assumption that insurance is the answer.  Maybe I’m just being naive, but it just doesn’t seem a given to me that medical insurance is the same thing as medical care.  My family has medical insurance and I recommend that everyone have it so they can afford the care they need if something terrible happens, but for the average person looking to obtain regular medical care, insurance doesn’t necessarily do much.

It’s surprisingly difficult to find clear information about what the new healthcare laws actually require, but I found the most helpful information at the Kaiser Family Foundation’s website.  Start by looking at their Timeline to understand what you can expect in the coming years.  Then click for details.  For instance, the information under “2014″ and then “Individual Requirement to Have Insurance” actually comes right out with all the important numbers: when (January 1, 2014), who (including exceptions to the rule), and how much is will cost.  The penalty is up to $975 for a family or 2% of their income, whichever is more.  The expected cost of insurance is $12,000-12,500 per family.  Again, maybe I’m being naive, but I expect a lot of people will choose to pay the penalty rather than pay for insurance.

Furthermore, from what I can tell, most of the affordable plans available will be high deductible plans.  Here’s one woman’s experience with a high deductible plan.  The new law will, if it continues unchanged, limit your deductible to $4000, which means that aside from covered preventative care, you must spend $4000 before the insurance will kick in, and at that point it will only cover a certain percent (as little as 60% from what I can tell) of the total cost until you get to an out-of-pocket maximum.  For preventative care and catastrophic illnesses and injuries, insurance is a great thing.  But for day-to-day medical expenses, for appointments and labs to monitor medical conditions, for stitches and casts, for illnesses, it won’t help much.

I’m not against high deductible plans…that is actually what my husband and I have chosen for our family because they do cost less…but my concern is that while this will provide guaranteed preventative care, it doesn’t solve the fact that the medical care that most of us need most of the time is astronomically expensive.  I’m glad we have the insurance we do because if my sweet husband ever cut off his hand with his table saw, my son had a major head injury, or I ended up in the hospital with an asthma attack, the insurance would keep us from going bankrupt.  But since we thankfully haven’t had any catastrophic events, we simply don’t use it that much.

I only need paps once every 3-5 years and my sweet hubby doesn’t need much in the way of preventative care at all.  My son gets a well child check once a year, but won’t be due for any vaccines until kindergarten.  Those are the kind of things that are covered by our plan.  We do pay out of pocket for everything: ingrown toenail removal, physical therapy, appointments for infections and injuries, prescription medications, counseling.  Eventually, we may have enough little things happen to add up to $4000, but in the meantime, the $8000+ a year we’re spending on our insurance is of no more use to us than our life insurance.  Insurance is something we buy hoping to never use.  I expect most families with high deductible plans are the same.

I do think the new law is going to benefit many people.  With a lower high deductible, a family will have insurance that is useful far sooner than with the current very high deductibles.  Everyone who has insurance will be guaranteed preventative care.  This means mammograms, colonoscopies, vaccines, and all those fun things will be a given.  Eliminating pre-existing conditions is beneficial, as is expanding Medicaid.  But for healthy individuals and young families who make too much to qualify for Medicaid, the benefits will be harder to see as they continue to pay inflated prices for doctors’ visits, laboratory tests, imaging, and medications.

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