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The Affordable Care Act - Does Anyone Understand It?

Updated on February 23, 2013

The Supreme Court ruled that the Affordable Health Care Bill did not violate the Constitution. Okay. So what the heck does it do? So far all I know is that young adults can stay on their parents insurance until they are 26 years old and that you can no longer be denied insurance for a pre-existing condition. And, although it is your choice to be insured, or not, you can be taxed if you choose not be be. Surely there must be more to this bill if contains over 2000 pages. Did I miss the "affordable" part in the news?

I don't get it. How do those stipulations make my health care affordable? Does it say somewhere in the bill that I will be charged a "reasonable" amount over and beyond the cost of someone who doesn't have a pre-existing condition? Is there a chapter that says a hospital can't charge me $200 for a box of tissues that I didn't ask for and don't need? Does my doctor still need to see 10 patients an hour, even if one of them is complicated, in order to be reimbursed by Medicare? Someone please, tell me how this is going to make my health care affordable.

My Personal Story

I carry my own private insurance and up until recently, I paid $655 a month for it. I am never sick. I am a Type II diabetic though and I take good care of myself. My doctor diagnosed me about four years ago when I had some vision changes. The Type II diabetes was caused by Prednisone, a steroid I was given 30 years ago when I developed a kidney problem due to a high protein diet I was trying out. How convoluted does that sound?

So, I took the Prednisone and my kidney problem vanished, never to return. My physician says I'm cured. So, when I applied for the health insurance, they considered me high risk and so I pay at a higher rate. This is in spite of the fact that I keep my blood sugar under control (no highs, no lows) and I eat healthy. My Hemoglobin A1c is 4.0 or less, meaning I'm not lying and that my blood sugar really is under control. My history of taking good care of myself is well documented in my physician's office and still, I am high risk. So each month I send a check for $655 for something that I simply don't use and, because when you need it, you really need it.

A few weeks ago, I called the insurance company to ask if there was a less expensive plan that I could qualify for. The agent said yes, all I needed to do was complete a new application. It took four hours to complete the on-line aplication, copying word for word from the application I submitted orginally. No wonder people just pay the premium and don't ask about reducing costs.

So, two weeks later, I get a letter in the mail telling me I've been denied for a pre-existing condition and...that the condition (my old kidney problem), is a life-time denial condition. Life-time! How can this be? It was on my original application. There have been no new scientific discoveries about this condition. Nothing is different since they approved me the first time. Another phone call to the insurance company, wading through the layers of "press 1", press "4", etc., and I finally get a person who tells me some underwriter caught it this time and I am no longer eligible to apply for insurance. That's when I asked about the insurance I was already enrolled in and was told it wasn't a problem. As long as I pay the premium, I am covered. I questioned the underwriter about other options and she smartly replied that i could wait for Obama-care to pass and then they could not deny me for a pre-existing condition. She neglected to tell me that they could raise my premium again. Affordable Care Act? For who?

The Right Road But the Wrong Turn

What I'm trying to say is that it was a good idea, making health care affordable. But somewhere along the way, it appears we took a wrong turn. Health care certainly needs to be reformed but it has to begin with controlling costs in hospitals and specialty offices. I worked for a health care system for 35 years. They were classified as a non-profit organization. Nothing could be further from the truth. They are the single largest employer in the region now and treat their employees like undocumented immigrants. It wasn't always like that. For most of my time there, we were encouraged to care about our patients and to do everything possible to reduce the cost o their stay. Now that system is just like any other big business. Gouge em' while we've got em' and if they don't pay, we'll take their home or business. It's just so wrong.

Where Do We Go From Here?

The best thing most of us can do is to get healthy; so healthy that we don't need to use that insurance that Washington is forcing us to buy or be taxed. That's my plan anyway.

I understand business. I understand the need to make more than is spent. Technology is expensive. I get that. I don't have a problem with adding weight to procedures to cover the cost of maintaining equipment or covering the cost of employee training. But $200 for a box of tissues? Hospitals need to be better regulated. And as consumers, we need to hold them accountable. We should ask for an itemized bill after being discharged from a hospital. And we should go over it, line by line. If there is something wrong, it will be obvious. How many boxes of tissues did you really use at $200 a pop? Seriously?

The Supreme Court decision today is a victory for Obama but not for us hard-working tax payers. And yet, reform has to start somewhere. But if there was ever a time for self-expression, it is now. As tax-payers and voters, we simply have to make our voices heard in the offices of our legislators. They work for us, don't they?

FOLLOW UP - JULY 5, 2012

At the encouragement of others, I have finally scanned all 900+ pages of the Affordable Care Act. There are many positives to this bill that have not received the attention of the media. The Obama administration has done a poor job of explaining this document to the general public. I think that the accountability for hospital charges will still be weak and without a doubt my current insurance premium cost will go up. Still, there are a lot of layers to the Affordable Care Act that give me hope that we at least have a real place to start the reform. I would encourage everyone to at least scan through the document. It isn't fun but it certainly changed my perspective.

Thinking Forward

September 4,2012

I like to go back and review things I've written, to see if my attitude or opinion has changed since the original writing. Sometimes I am surprised and sometimes not. In reviewing this hub on The Affordable Care Act, I think my attitude is leveling out.

There is a place for government regulation in some things, just not all things. I still do not think that the government should mandate that we have health insurance. I am perfectly ok with someone choosing not to have health insurance and being held accountable when the bills come in. There are some very attractive considerations in the Affordable Care Act. Thinking forward to post Novermber 6, when the Presidential race has been decided, I hope that there will be a renewed interest from both parties to refine the Act and make it a bill that really does help make health care affordable. As it stands now, it will not.

Campaign promises are just that, promises. Whoever wins in November, be it Obama or Romney or some third party candidate, I hope that we, the voters, will make our concerns heard loud and clear to their administration.

© 2012 Linda Crist, All rights reserved.

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© 2012 Linda Crist, All rights reserved.

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  • Josak profile image

    Josak 4 years ago from variable

    The poll didn't have an answer I agreed with... I suggest you read the bill I suspect you will find many things you like in there, people no longer being turned away for preexisting conditions being just one of them.

  • mikelong profile image

    mikelong 4 years ago from The largest convict colony in the United States

    I didn't find the choice in the poll that I agreed with either. I look forward to seeing what the future holds concerning this act's implementation. I am glad the "it's not Constitutional" excuse has been thrown out the window....now all those folks who refused to read it for that reason can educate themselves.

  • lrc7815 profile image
    Author

    Linda Crist 4 years ago from Central Virginia

    Josak - I'm not opposed to the bill but I don't see where the term "affordable" is applicable. Yes, I do know that pre-existing conditions will not be used to turn people away but trust me, they will pay the price and for the majority, it will not be affordable. Read my section labeled "Personal Story" again. I am a middle-aged, single income home. I was recently laid off. I was laid off four years ago and spent my savings covering my monthly expenses. I had no debt then. I have no debt now. I get a little more than $250 weekly from unemployment. My health insurance is already $655 a month. You do the math. Think housing, food, car expenses, clothing, utilities. Can I afford another increase in my health insurance. Not !

  • Josak profile image

    Josak 4 years ago from variable

    Your health care will be free if your income is that low, the point is people who can't afford it will not have to pay for it, people who can afford it will take a slightly higher cost. Good news right?

  • lrc7815 profile image
    Author

    Linda Crist 4 years ago from Central Virginia

    We can agree that the constitutionality was an "excuse". And I too am glad it has been tossed. I am slightly shocked that the "mandate" was upheld. I feel so strongly that reform is necessary but I am not confident that this Act will accomplish what really needs to change. I could be wrong and I hope that I am.

  • Davesworld profile image

    Davesworld 4 years ago from Cottage Grove, MN 55016

    There ain't no such thing as a free lunch. This will end up costing us much more over the long term for less effective health care than we had before the bill was passed. There is simply no way that millions of new people can be added to the insurance rolls without causing premiums to sky rocket. Can't be done.

  • lrc7815 profile image
    Author

    Linda Crist 4 years ago from Central Virginia

    Josak, I honestly don't understand all the details of this Act enough to argue but I can assure you of this -

    My health care will never be free. I've never taken a hand out. I've earned every dime I ever made. Keep in mind that I worked in health care and quite a lucrative income for 35 years. But I also had a bird's eye view of the waste and corrupt billing practices. I am not surprised that in today's economy, when many businesses are closing their doors, health care is still growing jobs. My issue in this Hub was the misrepresentation of the term "affordable". Nothing more. On a more positive note, I am actively looking for a new career opportunity and can't wait to be gainfully employed again and away from this 24 hour a day media circus. lol

  • Mmargie1966 profile image

    Mmargie1966 4 years ago from Gainesville, GA

    Nothing is for free...except love. Believe me, we will all be paying!

  • harmony155 profile image

    harmony155 4 years ago from Atlanta, Georgia

    Irc7815: you will definitely among all Americans benefit from ObamaCare. It is a blessing for you and your children and anyone else in your same shoes. Your children will more likely continue with Medicaid and you will have a cheaper and better healthcare plan available to you ( unless of course you land a job that provides insurance). Good luck to you!

    Pls read obamacare in detail so you can see your personal benefits :)

  • lrc7815 profile image
    Author

    Linda Crist 4 years ago from Central Virginia

    Harmony, thank you for your comment but Medicaid is not an option for me. I earn and pay my way in this life and will continue to do so without hand-outs. Medicaid abuse is part of the problem. Landing a job with insurance? Now that presents another dilemma. If I give up my private insurance for an employer's plan and then get laid off again, I will pay even higher premiums for a new policy. It isn't worth the risk, in my opinion. So, I'll keep what I have and find a way to pay for it. I still think the real problem has not been addressed and that is regulating what hospitals can charge for services. And if we continue to push physicians to see more patients per hour (like Medicare does now), the quality of care we will get will be the price we all pay. I'm not opposed to reform at all but I think we're leaving a lot out. I'll read the Act again to see what I missed. Thanks for your well wishes.

  • harmony155 profile image

    harmony155 4 years ago from Atlanta, Georgia

    Think of Medicaid as God's hand-out to help you through a rough patch in life. We all need a little help from time to time :)

  • lrc7815 profile image
    Author

    Linda Crist 4 years ago from Central Virginia

    Harmony, you are very kind and encouraging. But, God gave me good health, a fairly good brain, strong will, and I will be fine without Medicaid. There are others who need the help that don't have what I have. Your point is noted though. :-)

  • wba108@yahoo.com profile image

    wba108@yahoo.com 4 years ago from upstate, NY

    Government regulation tends to erect excessive barriers to entry into the healthcare sector thereby driving costs up. What is needed are free market solutions, that will force insurance companies and medical providers to compete for medical dollars. The poeple using the medical services should be the ones who control the medical dollars because they'll have a much greater incentive not to overuse thier own money. This is why the government should incentivise individual health savings accounts and disincentivise employer based plans which provide little incentive to individuals not to abuse.

  • lrc7815 profile image
    Author

    Linda Crist 4 years ago from Central Virginia

    wba108 - that too is another good angle. There are no truly simple solutions simply because we are dealing with human beings and human nature. We are each motivated (or not) by varying circumstance.

  • wba108@yahoo.com profile image

    wba108@yahoo.com 4 years ago from upstate, NY

    This is why I believe in free market solutions because poeple must have incentives to both produce a better health service and for health consumers to shop wisely for health services. Its a win-win situation, you improve services while limiting costs!

  • bn9900 profile image

    Clayton Hartford 4 years ago from Alger WA

    It's scary to think tat there are people in this country that think that healthcare should be free, If its free someone has to pay for it. And my question for those reading this hub is why should I pay higher premiums "because I might be able to afford it" for someone else benefit?

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