Why I Love Obamacare
Calling all facts about the Affordable Care Act
The Supreme Court has ruled that the Affordable Care Act (Obamacare) is constitutional. This is a very controversial issue; some people may be initially turned off by my title. I kept hearing conflicting things in the media so I decided to find out for myself what Obamacare really entails and what it would mean for me and my family. I now realize how much misinformation is being circulated so it's my goal to provide an accurate summary of what Obamacare truly does and what it means to families and individuals across America. It truly will help many families in a big way.
How do you feel about Obamacare?
Are you for or against Obamacare? Why?
My personal opinion on health care reform
Take it or leave it
Let me start with what I think and then I'll tell you what I know. I think that as one of the richest nations in the world we have a responsibility to provide access to affordable healthcare. I've experienced firsthand that there are two big problems with health care in the United States. The first issue is in regard to quality of care and the second is how prohibitively expensive it is to have access to that care.
There are so many people today unable to make enough income to support their families and it's not because they're lazy. As a business owner I used to have to spend hundreds of dollars to recruit a new employee. Now I only have to post on Craigslist and I'll receive hundreds of applications within an hour. Many of those applications will be from totally over-qualified individuals. People with master's degrees will apply for an entry level clerical position. They are willing to take jobs way below what their education should entitle them. Does this mean if something happens to them health wise and they can't afford the exorbitant cost of care that they should be left to die or go bankrupt? I don't think so.
I grew up in a progressive Midwestern city that offers fantastic health care. The clinics were clean, safe, and comfortable. Better yet my Dad worked for the state so we had great health insurance. So great that I cannot remember a time in my life where we had to put out a single cent for co-pay, deductible, or other such expense. When I heard of healthcare reform I was genuinely confused about what was wrong with the system. People never truly understand that something needs to be fixed until they experience the problem first hand.
The first time I understood that something was wrong was when I accompanied my dying Mom to New York. We were there to obtain a second opinion from the renowned Memorial Sloan Kettering. This was after our local doctor had said that my Mom should go home and die; there was nothing else he could do for her cancer. The day we arrived she got very sick and was doubled over in terrible pain. We called an ambulance to be told there was a 3 hour wait for a vehicle. I had never heard of such a thing. Memorial Sloan Kettering said they wouldn't admit her since she was not yet a patient there for a couple of days. So we took a cab to the nearest public hospital and then proceeded to hurry up and wait. Wait the entire night in a dirty, disgusting waiting room. We were surrounded by drunks. No one made any attempt to help my Mom out of her excruciating pain. The hospital was just too full and too busy. I hope no one else has ever had to experience watching someone you love go through that kind of experience without having any ability to help them. Many hours later we were brought to a temporary ER room. It didn't have a single chair beyond the table for my Mom to lie on. The floor had multiple pieces of bloody gauze and splatters of blood. We were there so long and I was so exhausted I ended up sitting on that disgusting floor. She was later formally checked into the hospital after over a day of waiting.
At one point my Mom was taken away to get some tests. She had been gone an exceptionally long time. I finally went to look for her and found her on another level in the hallway- abandoned and throwing up. I started to push her back to her room and was informed by staff I wasn't allowed to push her and a staff member would have to take her. I was only 20 at the time but I had to be her voice. Let's just say that a staff member became available very quickly.
That whole New York trip was hands down the worst experience of my life. I pledged to myself at that time that when I was older and in any position of power, wealth or influence that I would become an advocate to improve quality of care.
My personal health insurance and medical expense story
The first time I understood something was wrong with health insurance was when I became pregnant with my first child. I had a personal insurance plan since my business is small and could not afford to provide a group plan. My plan didn't cover pregnancy as most individual plans don't. If they do it's for an astronomical premium and after an extended wait period. So much so that you may as well just pay for the pregnancy since paying those high premiums for years while waiting to be allowed to become pregnant would cost just as much in the end. I decided to skip the wait and pay out of pocket. I thought I would be smart and pay up-front and receive the cash pay discounts available. I paid the hospital many months before I was due to lock in the current year's rate. It seemed that the whole thing was going to cost around $6,000 including pre-natal care, testing and the delivery. Unfortunately my daughter was breach and I ended up having to do a c-section. The bills kept coming and coming. When all was said and done I spent $16,000 cash not counting what I was paying each month on health insurance premiums.
The one silver lining or so I thought was that my policy did extend coverage for pregnancy complications. Their policy definitions included a c-section as a covered complication. I submitted the claim to my insurance and was denied. I filed a complaint with the director of insurance in my state which I won after several months. Happy day I thought I was going to recoup some of my money. That was not to be the case... My first problem was the insurance company took the expense for my daughter and the expense for me and we were each subject to separate deductibles and co-pays. Then the insurance company paid the hospital what was left and left the hospital to reimburse me.
This is where things get interesting. I had already paid the hospital thousands and thousands of dollars and was considered paid in full. Yet when the hospital received thousands of extra dollars from the insurance company they changed me from cash pay to insurance pay. This means that the exact same services now cost much more. On a phone conversation with the hospitals billing department I was informed that they would try to work it so that I didn't owe any additional money. What? In the end they mailed me a check for exactly $100.00.
This was a very eye-opening experience. Hospitals and medical providers can charge whatever they want. I once paid for a pap smear when I was uninsured and had asked what the cost was upfront. I paid around $120.00. Around the same time my sister received a bill in the mail after a pap for $750. In my pregnancy experience the hospital could profit from my original fee. When sent more money they just changed the fee so they'd be entitled to keep it.
Insurance companies are for profit. To cover increasing expenses they have to either raise rates or further reduce coverage. Part of why hospitals need to charge more to clients with insurance is to cover the expenses of those without insurance that never end up paying their bill. It's estimated that this inflates prices that insured customers pay by an average of $1,100 per year. This experience made me realize that there were problems not just with quality of care, but a major problem with how the entire health insurance and medical system works as a whole.
1. I should not have needed to go to the my state's Director of Insurance to get my claim paid. Anyone who knows how to read would have clearly understood that my situation was covered under the policy. As someone who works in the insurance industry I understand that insurance companies will deny claims and hope that the insured either doesn't have the desire or knowledge of how to pursue it. This is a totally unacceptable and unethical process.
2. Something needs to change in the cost of medical care. The price should not be arbitrary depending on who's asking. Medical care is not a luxury it is a necessity. People need affordable access to it.
Do you think the U.S. needs health care reform?
Regardless you believe in Obamacare or otherwise, do you believe the U.S. needs some sort of Health Care Reform? Please elaborate
The Story of the Affordable Care Act
Myths about Obamacare
There is a lot of misinformation, lies and rhetoric being intentionally circulated purely to suit one's political agenda. I believe it's important to understand what something truly is and what it does before taking a stance on one side or the other.
- OBAMACARE IS A FEDERAL TAKEOVER OF HEALTH INSURANCE
One of the main purposes of the law is to deliver millions of currently uninsured individuals to PRIVATE insurance. It does not include a public option and is not a form of universal coverage.
- OBAMACARE IS A JOB KILLER
The law will result in the loss of a small amount of low-wage jobs which will be offset by an increase in higher-wage jobs. It is also estimated that some employees will retire sooner because they no longer need employer sponsored health insurance. However this is a positive because it means that someone who wanted to retire now can. Plus their job then becomes available for someone else who wants it.
- OBAMACARE IS IN PART BEING FUNDED BY CUTS TO MEDICARE
In reality Obamacare is actually going to increase spending on Medicare. It has introduced a discount to help reduce the doughnut hole on prescriptions for Medicare recipients. It plans to completely eliminate the doughnut hole by 2020.
- OBAMACARE IS FINANCIALLY BAD FOR SMALL BUSINESSES
Businesses will not be required to provide health insurance unless they have 50 full time equivalent employees or more. This is not a very small business. Millions of small businesses are now eligible for a tax credit to help pay for health insurance costs and that credit will increase up to 50% by the year 2014. Independent estimates suggest that small business health care spending will actually decrease by 9%.
What is the Affordable Care Act really? - 15 Reasons I Love Obamacare
Some of the benefits are available immediately and other things will slowly roll. The plan will be fully implemented by 2020.
- Insurance companies can no longer deny coverage for pre-existing conditions.
- If you have a pre-existing condition you can get coverage through the new Pre-Existing Condition Insurance Plan.
- Insurance companies can no longer drop someone when they become sick.
- Children can remain on their parent's policies until age 26. This will bring more profit to health insurance companies. This is because they will receive more premiums without higher costs for these healthier individuals and this is a group of people who often go uninsured.
- The Medicare doughnut hole gap in coverage will be eliminated which will improve coverage and decrease costs for senior citizens.
- The maximum income to qualify for medicaid will be expanded to 133% of the federal poverty level. This is approximately $29,000 for a family of four.
- Those who don't qualify for Medicaid will receive significant tax credits as long as their income is below 400% of the federal poverty level. This is approximately $88,000 for a family of four.
- The act is expected to lower the budget deficit by $143 billion over the next 10 years. This will be achieved by raising some taxes and shifting more cost burdens.
- Large tax credits will be available to businesses to offer health insurance for their employees.
- Policies will no longer be able to exclude covering events like pregnancy. Minimum standards will be established. Now if you pay for health insurance and you need health care you'll have coverage.
- Lifetime coverage caps will be banned. This can literally save someone's life or at a minimum prevent them from bankruptcy.
- Insurance companies must use at least 80 percent of your premium for health services and improving care. If they don't then you'll receive a rebate check.
- Insurance companies will have to justify any premium hikes before an independent panel which will help keep premiums down.
- Certain preventative services will be included with health insurance policies such as check-ups, screenings, birth control and more. These will not be subject to a co-pay or deductible.
- Premiums will no longer be higher for women or people with pre-existing conditions (excluding tobacco use).
Health Insurance Requirement Poll
One of the components of the health care reform bill is that it will be required that all U.S. citizens carry health insurance. It can be purchased through work or on a personal basis. Low income families still have the option of applying for Medicaid. Mid income families will receive subsidies to help offset the cost of a personal policy.
Auto liability insurance is required for street legal vehicles on U.S. roads. This is for the protection of others rather than for the driver. Should health insurance also be required since costs of the uninsured can affect other citizens or do you feel it should be an individual’s choice?
Do you believe everyone should be required to have health insurance? Why?
Further Reading on Health Care Reform
Has this Obamacare Lens changed your opinion?
After reading this lens has your opinion of Obamacare been affected at all?
© 2012 Melissa Miotke