The Patient Protection And Affordable Health Care Act – Is Obamacare Healthy For America?

The American public is totally divided about the merits and demerits of Obamacare. The whole episode has also become a contentious political issue. However, people who oppose the Health Care Act seldom understand the true benefits that it can bring to the people of America.

The main focus of the Act is to bring as many people as possible under health insurance coverage. When the Act is enforced, people would be adequately covered by health insurance, and enjoy the benefits of Obamacare. Here is a brief overview of the real benefits of the Affordable Health Care Act.

First of all, insurance companies will not be allowed to discriminate based on the pre-existing conditions of applicants. Currently, guaranteed issue is mandatory only in the small group market. Employees who are enrolled in a company with a size of 2 to 50 employees alone currently enjoy this benefit. People who apply for insurance in the individual health insurance market can be denied insurance in many states based on their pre-existing condition. Obamacare seeks to eliminate this practice by requiring all insurers to offer uniform premiums to all applicants of similar age and geographical location, without taking pre-existing conditions into consideration.

Under the provisions of the Act, insurance companies offering individual or group health insurance coverage to dependent children of the policy holder would be required to extend that coverage until the child is 26 years old. Therefore, a number of youngsters can benefit from their parents’ health insurance coverage until they turn 26. This would benefit most youngsters who are struggling to pay for their personal health insurance coverage. In case these youngsters have children of their own, those children would not come under this coverage however. Thanks to the Act, six million young people would now enjoy health insurance coverage.

Obamacare also comprehensively addresses the infamous ‘donut hole’ problem in the Medicare Part D program. From 2010, eligible seniors who entered the donut hole were issued a $250 rebate check. In 2011, they were entitled to receive a 50% discount on branded medications within the donut hole. The prices of generic Part D drugs were also discounted. From 2013, even the cost of branded Part D prescription drugs would be discounted. By 2020, the hole would be completely eliminated. Seniors who are on a prescription drug plan will continue to receive Part D coverage throughout this period.

These are some of the benefits of the Affordable Health Care Act. Just as auto insurance is mandatory in the United States, the Act strives to make health insurance also mandatory so that every American can enjoy affordable health care.

What Is To Blame For Less Affordable Health Insurance?

A recent statistic from global consultancy Hewitt Associates is sobering. As reported in Newsweek magazine, employers’ health insurance costs will rise by 8.8 percent in 2011. That is the highest level in five years.

Obviously, the blame game has already started. The Barack Obama administration, along with many liberals, have put the blame on allegedly greedy health insurers. According to progressives, insurers are jacking up their rates beyond either general or medical inflation in order to maximize their profit margins before new regulations and consumer protections go into effect. These actions also have the side effect of decreasing support for the legislation among those who decide that the correlation is the same as causation–although that remains to be proven.

Meanwhile, health insurance companies are blaming politicians. Specifically, in the future they will be mandated to provide coverage for more preventative care conditions. Although some experts predict that doing so will lower their costs in the long run (by having their customers avoid developing chronic diseases that are expensive to treat), it is more costly in the short run.

The healthcare reform provision that will benefit insurers the most, the individual mandate, is not scheduled to go into effect until 2014–and the Supreme Court may end up striking that portion of the law down as unconstitutional. Meanwhile, this week brings the requirement that group health insurance companies allow the adult children of employees to remain on their coverage until the age of 27; in a recession that has left millions in that demographic unemployed, a high percentage will probably take advantage of that benefit. Meanwhile, annual or lifetime coverage limits have now been banned.

Insurers also feel that they need to earn as much money as possible before the medical loss ratios kick in, which will not allow them to spend over 20 percent of the premiums they collect on administration and profit. As some consumers drop their coverage due to cost, they must charge more to existing policyholders.

Most likely, all of these elements should share blame for the rate hikes. Unfortunately, it is the average American who is left with less affordable health insurance. Employers are passing an increasing percentage of out-of-pocket costs to their workers.

The Affordable Alternative to Traditional Individual Health Insurance

As a way to begin let’s define what I mean by traditional health insurance. The traditional health insurance policy is composed of:

The deductible – This is the amount that you have to pay for a medical event before your health insurance will start to pay. In today’s world that deductible is often $3000 or more.

The coinsurance – After the deductible is met most policies require that the insured pay a percentage of all medical costs up to a maximum. Usually the insured pays anywhere from 20% to as much as 50% of every dollar billed.

The copays – In an attempt to make routine health care accessible many policies include a copay for doctor visits and prescriptions in lieu of having to meet a deductible. An example of this is the $10 office visit copay.

Maximum Out-Of-Pocket Costs – This is the most that an insured can expect to pay regardless of how large the medical bills are. As a general rule the maximum out-of-pocket costs for an individual are limited to around $7000. This can be a very misleading number because it assumes that all of your providers are in your network. If they are out of network your costs can be significantly higher.

And finally the “Network” – Virtually every traditional individual health insurance policy is tied to a network of providers. The narrower the healthcare network, the lower the premium. There is too much wrong with “networks” for this article. Suffice it to say that “networks” are the enemy of the healthcare consumer (you).

The Problem Facing Working Americans

The problem is simple: health insurance premiums are too high for most working Americans in the absence of a subsidy and when combined with extremely high deductible and out of pocket costs, healthcare becomes unaffordable. Let’s look at a couple of examples right here in North Carolina.

A non-smoking couple ages 62 and 63 find that their lowest premium option with BCBS of NC is $1999 a month for a $13,300 family deductible with no copays. A plan with a $7000 deductible and $25 office visit copays would cost $2682 per month.

Assuming the least expensive plan the annual cost would be $23,988 annually. And if either person had a medical event such as cancer, the actual cost for healthcare would be $37,288. You have to ask: “Why even have health insurance?”

A non-smoking 30 year old couple found that the least expensive plan would cost $787.84 a month for a $13,300 family deductible with no copays. The least expensive plan that included copays was $1056.88 but had a $7000 deductible and the most restrictive network. Assuming the least expensive plan, should either member of this young couple have a medical event their total annual cost (deductible + premium) would be $16,454.08. That is a devastating amount of money for a young couple.

The simple solution to this problem is a Fixed Benefit Health Insurance. Unlike a major medical policy where the policy pays for all eligible expenses after the deductible and out-of-pocket maximum, a Fixed Benefit Health Insurance Policy states exactly how much will be paid for each specified service. Examples of specified services might include: daily benefit for in-hospital stay of 24 hours, specific dollar benefits for specified surgeries, a specific benefit for doctor visits and other specified charges. A great Fixed Benefit Health Insurance Policy will have very robust benefits, a wide range of specified covered charges, a very comprehensive surgical schedule and more. The most important service that Fixed Benefit Health Insurance Policy can include is medical bill negotiation, a service that can significantly reduce out-of-pocket expenses.

What is really great about this type of policy is that empowers the insured to be a better consumer. Knowing how much your policy will pay you for a specified medical service allows you to better shop and negotiate the price. But the really great thing about this policy is the affordable premium.

The couple ages 62 and 63 are an actual client of mine who had been uninsured for 5 years as a result of the high premiums. I was able to put them into a robust Fixed Benefit Health Insurance Policy with a $5,000,000 lifetime benefit for $683 a month. That is an annual savings of $15,792. As I explained to my client the Fixed Benefit Health Insurance Policy will do a great job of covering 70% to 80% of everything that can happen. If they actually saved the $15,792 difference in premium they would have incredible access to healthcare with very little out of their own pocket.

Back in 2014 I was diagnosed with colon cancer and had a partial removal of large intestine (CP44205). Back then I was covered on a traditional major medical policy. My total out-of-pocket costs were more than $7000. Had I had the Fixed Benefit Plan that I sell today not only would my costs have been zero but I would have received a check from the insurance company for $4619. Not every medical event would have resulted in a check and many might have resulted in out-of-pocket costs of several thousand dollars, but in general the savings would have more than offset those costs.

So, before you choose to go without any health insurance I strongly suggest that you take a hard look at a Fixed Benefit Health Insurance Policy.