The ObamaCare Wolf, Scratching at Your Door
"It's awful," the stressed-sounding voice on the phone declared. "It's just awful."
The voice belonged to my primary care doctor's office manager. She had just told me that my doc would not accept my health insurance in 2016, and that the nearest physician who would accept it is in a town a thirty-minute drive away. She was describing the dilemma that many of the doctor's patients now face. For our health insurance -- which we are now required by law to purchase, of course -- to be of any value, we will have to make an hour-long round trip just to see a doctor.
"If you like your health care plan, you'll be able to keep your health care plan, period."
The problem isn't that my insurance is from some fly-by-night insurance company; it's from one of the country's largest providers. Nor is the problem caused by a lack of doctors in our community. While relatively small -- its population is about 20,000 -- the town I'm in has a large medical community for its size. It's something of a retirement community and, with the various medical needs of a primarily older population, has accredited specialists in almost all fields. Further, it has both a regular hospital and a VA facility.
The problem is that the insurance company (not to name names, but it rhymes with Sue Moss), with which I've had an individual health insurance policy for a decade or more, has cancelled, not just my policy, but the entire class of such individual health insurance policies they'll offer in my area.
Not only can I, and many other people with individual policies, not keep our plans, but we can't even keep the type of plan we had before.
Before, I had what is termed PPO (Preferred Provider Organization) policies. These policies encouraged patients to see doctors in the insurance company's network, but would provide at least some benefits if the doctors were not in that network.
Starting in 2016, the company has cancelled PPO policies, in my region at least. It is now offering only HMO (Health Maintenance Organization) policies. HMO policies do not provide benefits for doctors who aren't in the company's network.
One other thing about the HMO-type plan: unlike the PPO plan, to see a specialist the patient is first required to see their primary care doctor to get a referral. Thus, another hour-long round trip -- and lengthy wait in the doctor's office -- to get a referral, whether it's to see a new specialist or the one specialist I've been seeing who'll accept the new policy.
HMO policies are also (a little, at least) cheaper than PPO policies. One reason is that the companies negotiate lower fees with doctors.
"If you like your doctor, you will be able to keep your doctor, period."
Doctors are not dumb. In my town, at least. They've decided that they're not going to lose money just because the big, bad insurance company told them to.
My primary care physician, and the three specialists I regularly see, were all in the company's PPO network. They're not in the company's HMO network. Now, to continue seeing my primary doc, who knows my medical history better than anyone else, and two of the specialists, I'll have to pay out of pocket.
That would be entirely reasonable according to my values, except that I will -- by force of law -- be paying $480 a month for a health insurance policy that, essentially, I won't use. Unless I decide to make that hour-long round trip -- and even then only if I can get in to see the doc in the other town. (As the only HMO primary care provider in the region, he's probably already overbooked.) Or unless -- and this is the biggie -- something catastrophic happens: a heart attack, serious injury, or other major medical condition which would otherwise bankrupt me.
Before the (Un)Affordable Care Act, or (U)ACA, I paid $336 a month for a PPO plan with a $3500 deductible (the amount the insured pays before the insurance company begins paying for most or all reasonable medical costs.) At the time, that was considered a high-deductible policy. Under that policy, again before the (U)ACA, I would have spent a maximum of about $7,500 a year for health care: the cost of my insurance and the cost of my out-of-pocket expenses.
This year, my PPO policy with the same company cost $570 a month with a $5000 deductible. Because of some conditions that have developed, I almost -- but not quite --reached the deductible in out-of-pocket medical expenses. That means my total medical costs, health insurance plus expenses, in 2015 totaled approximately $11,800.
Under the (U)ACA, my premium from the same company for essentially the same policy shot up 69%, my deductible went up 43%, and my total potential medical costs -- which were realized in 2015 -- increased by 57%.
That's the bad news. The good news is that -- thank you, Sandra Fluke -- I, as a middle aged man, now have access to free birth control pills.
That brings us back to the insurance company's decision to offer only HMO plans in my region. The plan I've chosen is their next to cheapest: $480 a month, with a $6,000 deductible. Thus, if I again near my plan's deductible this year -- which appears likely, given that my medical conditions aren't the kind that are likely to improve -- I will spend almost exactly the same amount of money ($11,760) as I did last year, but for a poorer quality plan with fewer choices in providers.
Only one other insurance company offers health insurance policies for people in my area. It does offer one PPO plan that doctors might actually accept... for $800 a month, with the same $6000 deductible. Total health expenses under that plan, essentially the same as I had before the (U)ACA -- would be $15,600, or an increase of 108% from before Democrats rammed this misguided policy down our throats.
I should point out that these are not 'ObamaCare' policies. They are individual policies bought directly from the insurance companies, not from the ObamaCare Exchange.
Why should this matter to you? So far, the major harm wrought by the (U)ACA has fallen on individual health insurance policy holders. We represent only 6% of all Americans, according to the Kaiser Family Foundation. They say eight times as many people get their health insurance through group policies from their employers. To minimize the political blowback, the Obama Politburo, uh, White House has postponed implementing many changes for employers' policies until 2016.
If the experience of individual policy holders holds true, and it should, those employers' health plans will soon see similar price hikes and service cuts. Many employers -- as even Obamacare-cheerleading PBS admitted -- will just drop health insurance forcing their employees to buy health insurance on their own, leaving them in the same vulnerable position as those of us who already have individual policies.
Either way, Americans who currently have health insurance through group policies will soon have fewer choices in doctors, costlier premiums, increased deductibles, and much higher -- possibly economically devastating -- overall health expenses.
Numerous studies show that as the cost of health care rises, people delay or refuse treatment, leading to more serious medical conditions, even death.
In the light of all the above, let's look at Obama's full quote about the (U)ACA:
"(N)o matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what."
It was declared Lie of the Year -- actually it should be Lie of the Decade, or Century even -- by left-leaning Politifact in 2013.
Obama lied. People will die.
It's awful. It's just awful.