Pre-ACA, Insured Face Exorbitant Costs.
With Accountable Care Act, People Will See Caps, Save $$

Vast numbers of Americans do not understand how the Affordable Care Act will make their expenditures for healthcare a heck of a lot more affordable. I am talking about the 80% of American voters who have insurance now, who misguidedly think it has them covered. Medical bankruptcies are up and they are happening to people like you and me because of unanticipated, unaffordable health expenses.

This week, I am sending money to a friend with breast cancer who has four children and insurance. Her friends are planning a fundraiser. She has had 6 surgeries and she can’t keep up.  She’s got breast care drugs that she cannot afford and no lifetime or yearly caps. I know someone else who delayed investigating a breast lump because she had to get herself insurance first. Now she’s stage IV and providers are after her daily for $$.

It’s not just cancer, although it is the first thing that often comes to mind. It’s mental health care that is not available for many Americans. It is what happens when someone suddenly has a debilitating stroke or progressive illness, or becomes disabled. Or drugs for HIV that suddenly become cut from the federal budget and thousands of HIV-positive Americans are without drugs. Annual and  lifetime caps, an end to pre-existing conditions, and insurance exchanges, and so much more,  have to be made plain to everyone.

It’s time to step up sharing specific examples of how people fare pre-ACA versus post-.  We need to move beyond generalities and intangibles to real-life hardships.  Social Security and Medicare, also faced early challenges and a skeptical public. I hope to share more stories here of real people who are going broke, barely staying alive because of current health policies. Many are insured, but can’t keep up.

If you are bored and feel like you have heard these vignettes many times before, make a contribution for the public good: try these real-life stories out on people who think catastrophic expenses could not happen to them. There are thousands more stories like this. Sadly, it is not unlike the AIDS Quilt.

We are in a precarious period. I urge you to get angry and seek out these stories. You won’t need to look too far. Get these stories around. RT them, tell them at parties. Let’s be sure the Affordable Care Act and all its essential public health infrastructure stand.

If you’ve got a story to tell, share it in the comments. If it’s too long, write me at “patientpov” at “gmail dot com.”

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4 Responses to Pre-ACA, Insured Face Exorbitant Costs.
With Accountable Care Act, People Will See Caps, Save $$

  1. norman says:

    During the healthcare debate, Robert Kuttner wrote in the New England Journal of Medicine that the problem with the Massachusetts system, with plans like the ACA, is that they’re regressive taxes. If insurance costs $10,000 a year, and you’re making $20,000, that’s a 50% tax. If you’re making $100,000, that’s a 10% tax. They correct the regressive aspects with vouchers and tax deductions.

    Now that the ACA passed, I’m trying to figure out the numbers.

    As I understand it, people with individual incomes under ~$45,000 will get vouchers and tax deductions. According to the CRS:

    Poverty Income Premium Premium
    level %
    100% 10,850 2.0% 217
    200% 21,700 6.3% 1,367
    250% 27,125 8.0% 2,170
    400% 43,400 9.5% 4,123
    Now 7,200

    (2009 dollars)


    (I’m using my own insurance 2009 payments of $7,200 for comparison.)

    So far so good. We’ll be paying lower premiums.

    However, my $7,200/year plan had essentially no deductibles or copayments. (I believe that deductibles and copayments are bad policy.)

    When you include the out-of-pocket (OOP) deductibles and copayments, it’s not so good:

    Poverty Income Premium Premium OOP Total
    level %
    100% 10,850 2.0% 217 2,000 2,217
    200% 21,700 6.3% 1,367 2,000 3,367
    250% 27,125 8.0% 2,170 3,000 5,170
    400% 43,400 9.5% 4,123 4,000 8,123
    >400% >43,400 9.5% >4,123 6,000 >10,123
    Now 7,200 0 7,200

    For those who are lucky, and don’t have big medical expenses that year, it’s a pretty good deal. (Of course, if you were lucky, you wouldn’t need any health insurance.)

    For those with incomes of =<$27,125, it still seems better than what we've got, even if they ran up big expenses, as they would with a chronic disease or serious illness.

    However, 6.3% ($1,367) of your income is a big hit if you're only making $21,700. A trip to the emergency room, or a biopsy for a suspicious mammogram, can bring it up to $3,367. That's 16% of your income. The purpose of insurance is to avoid that kind of exposure. People with chronic conditions, like diabetes or heart disease, will meet the maximum every year.

    There’s a reason why people with incomes of $21,700 don’t buy health insurance: They have to spend that money on other necessities, like rent, food and working expenses. Hitting them with $3,367, or even $1,367, is a hardship, which might drive them into bankruptcy unrelated to health care. So you’re exchanging a few big bankruptcies for a lot of little bankruptcies.

    Kuttner said that the solution was a Medicare-for-all single payer system. Canada gets outcomes equal to ours for half the cost, according to the systematic reviews we like so much. Kuttner said single payer was tremendously popular in the polls, politically possible, and Obama could have done it if he wanted to. The Obama administration’s response, through Rahm Emanuel, is unfortunately not printable.

    During the campaign, Obama said that solving the health care problem by requiring everybody to buy insurance makes as little sense as solving the housing problem by requiring everybody to buy a house. It’s unfortunate that he couldn’t or wouldn’t deliver a sensible solution.

  2. Laura Newman says:

    Your points are well taken. Indeed, single payer would be ideal.
    But it should be noted that even folks like Michael Moore are supportive of healthcare reform, imperfections and all.

  3. Laura Newman says:

    Your points are well taken. Indeed, single payer would be ideal.
    But it should be noted that even folks on the left like Michael Moore are supportive of healthcare reform, imperfections and all.

  4. Dolores Rogers says:

    Very valuable.

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