As we read report that the amount of uninsured Americans has been reduced under the Patient Protection and Affordable Care Act (PPACA), otherwise known as “Obamacare”, we are also seeing changes not necessarily for the better. First I would debate how much the law has reduced the uninsured. I think more people are working so as the employer group insurance improves so will the uninsured rate.
Having health insurance does not give you access to health care. Many insurance carriers have narrowed their network of doctors in an attempt to reduce their premiums. With a smaller network, the idea is to drive more clients to fewer doctors and hospitals. Generally, these networks do not reimburse the medical professionals as much for medical services provided but try to make it up in volume.
Another area where the ACA seems to be failing is in regards to the Emergency Room. Supporters of the law claimed if more people had insurance, they would go to their primary doctors and not go to the emergency room.
A poll released on May 4, 2015, by the American College of Emergency Physicians found that 28% of emergency room doctors have seen large increases in patient volume since January 1, 2014. An additional 47% reported they had seen slight increases. Five percent of the doctors surveyed reported a slight decrease while none said a large decrease.
It is believed that the increase in patients at the emergency room is due to the expansion of Medicaid. Medicaid is coverage provided by the State. It also doesn’t pay doctors and hospitals as much as traditional insurance. Many doctors do not accept Medicaid for that reason, therefore those folks who cannot find a doctor end up in the emergency rooms for routine care.
Traditional major medical insurance coverage requires you to pay to go to the emergency room. Most have a fee just to go to the emergency room which is often waived if you are admitted. The charges associated with the ER are oftentimes applied to the policy deductible. Most states often do not charge the patients who are on Medicaid. The ACEP poll also revealed that 56% of emergency room physicians have seen an increase in Medicaid patients since the ACA took effect.
Another area where Obamacare has really missed the mark is with deductibles and out of pocket maximums. Most plans now in both the Silver and Bronze product line have out family deductibles of more than $6000 and family out of pocket maximums of over $12,000. Many Americans who purchase insurance on the individual market are self-employed or small business owners. If you are self-employed and have a major illness such as a heart attack, not only would you have to pay the $12,000 out of pocket, you probably would not be going to work for a while to earn income. So not only do your medical expenses increase, your income decreases at least temporarily.
The last area that the law is not working is in terms of premium. According to the National Bureau of Economic Research, in 2014 premiums grew in the non-group health market by 24.4% compared to what they would have been without Obamacare. The same study said premiums rose in all, but six states. Nine states had increases of over 35%. Now some people are fortunate to qualify for a subsidy to assist in paying for the premium. Also, the subsidy is paid for by the taxpayer. So every dollar paid out in the exchange, is a dollar taken from the American taxpayer. Much of the premium increase is due to the mandated benefits of the law. Also when you eliminate risk selection, your claims exposure goes up, which in turn increases the premium. Had the premiums not increased so much, the subsidy would not have been needed.
After turning our healthcare system upside down, higher costs and being the largest tax increase in American history, we still leave over 30 million Americans uninsured. Was it worth it?
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