Friday, May 12, 2017

My Analysis of the ACA and the New Healthcare Bill

There has been so much going around, as always I have a hard time finding a spot to begin. I've been researching the new healthcare plan, and it is not a good read. There are a few things that I find particularly disturbing. As always, these laws are drafted, and nobody probably bothered to ask themselves "so, once this is in place, exactly how is this going to work?". Has anyone thought of the practical side of things or thought to put protections in place to keep chaos from erupting? I think not.

Let's address the preexisting condition issue. I remember how the healthcare system worked prior to the ACA and after, after is better. If this law is passed, what is to stop an insurance company from deciding any expensive medical issues you have are due to a preexisting condition? Where would the proverbial burden of proof be? With the insurance company? Most likely it would be both with you and your doctor to have to PROVE any conditions you have are not due to a preexisting condition to them prior to them insuring you or paying for care. How far back into your history could they go? Do you have the records to refute it? Before you tell me that they wouldn't do that, I can tell you prior to the ACA, they had, and would still continue to do it if allowed.

Speaking of coverage, let's talk about gaps in coverage, or continuous coverage. Way back when prior to the ACA, when you switched insurance companies, the new company would demand you provide a "certificate of continuous coverage" before they would accept you on to their plan and provide you coverage. Obtaining one was not always easy then when accurate records were kept, how about now? Do we honestly think that insurance companies have kept accurate and detailed records of our coverage on their plans over the past 7 years or longer? Especially if we switched providers? Do we have records of which companies had covered us and the dates of when? If we worked for an employer that provided coverage and they switched plans or companies, do we have records of those dates? What happens if we don't? What happens if an insurance company withholds that information, or refuses to provide it in a timely manner to the new carrier? Where does that leave us? It's happened before.

There is another caveat to this as well; when having to provide proof of continuous coverage, publically funded insurance did not count. Many if not most large insurers would not consider a strictly Medicare, or Medicaid plan as a "legitimate" insurance company or plan to count as continuous coverage, so if someone was on those plans and didn't have any supplements, it was considered a gap in coverage and was used to deny coverage and services. Anyone thought of asking if this is going to be the case again? Probably not.

Oh and by the way, if you can't prove there aren't any gaps, you get a 30% surcharge.

There's another thing that everyone seems to be missing, and that is the allowance of insurance companies to charge up to five times as much for older adults as opposed to three times which is what it is currently now. When we see this in the news we often think of INDIVIDUALS sitting around having to pay more, and gee they talk about those folks getting tax credits to help them, so nice isn't it? What nobody says and nobody is addressing is the effect this could potentially have on BUSINESSES! See I'm sure insurance companies as a whole get some good dollars from individually issues insurance plans, that is not where their profits lie.

Their profits lie in plans they sell to BUSINESSES! The deeper pockets lie with BUSINESSES! This plan give the insurance company permission to jack up premiums! Let's face it, if you start increasing premiums for individuals too much, you will probably start to loose customers, but hey, businesses and corporations have deeper pockets, much deeper pockets, and they would not be in a position to cancel their plans as an individual would. Some larger companies would be able to eat the costs, and have to raise the premiums on their workers. Would this make them less likely to hire older or more at risk workers? Well, they officially can't do that, but would it be in the back of the minds of hiring managers? Would they start giving harder performance evaluations for older workers or try to push them out? It's hard to say at this point. What will this do to small to medium sized businesses? This could hurt them financially, deeply, and it might destroy some of them. Oh, but wait, under the new act, companies can offer plans that are cheaper with lifetime limits on expenses, to get a lower premium! So if someone has already reached their lifetime limit, even if they pay for it under an employer that selects this option, they would  not have coverage.

What exactly could the amount of a lifetime limit be? Any regulations or restrictions about that? For example: do you realize an insurance company could arbitrarily decide for a plan to $50,000 lifetime limit? That seems like a lot, but really, that would probably barely cover one emergency incident, illness, or surgery. Do doctors visits, and medications count towards the lifetime limit amount? Could they? Would an insurance company be able to do that? Who could stop them under the new plan? to put this in perspective, I'll break down some common medical costs (without insurance):

According to the National Heart, Lung, and Blood institute a typical emergency room visit would cost between $150 to $3,000. Someone that has had a heart attack would likely spend anywhere between $30,000 to $200,000 depending on the course of treatment.

A sick infant's stay in Neonatal Intensive Care or NICU hospital stay averages about $2,5000 a day just to stay in the hospital, that does not include consultations or procedures, and that adds up fast, a child could reach a lifetime limit prior to ever even leaving the hospital.

One other big thing is restricting funding to Medicaid and putting them on a "budget". Um, how did we determine that they needed to be on a budget? Was there any audits? Research into their financials as to how they are spending their dollars? Any mismanaged funds? What empirical, objective, detailed evidence do we have that this is the best course of action to take? I have yet to find any.

It is disturbing to me to say the least.

One other thing I find interesting, there has been little to no statements from any of the larger healthcare carriers on any of this. No reassurances that they will try to help anyone maintain coverages or benefits despite the laws. No plans on how they would act or implement these new changes, as a customer I find that disturbing as well.

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