Congratulations! You are now the proud parents of a new health care reform bill. Make sure to circumcise it within its first week of life, send it to public school when its old enough, plan and fund its college education, and give it a bar mitzvah on its thirteenth birthday.
Just kidding.
Seriously, I wasn’t against health care reform. I fully agree that we needed health care reform. What I did have problems with was the debate about it. I didn’t agree with everything the democrats said, but they had some valid points. I also didn’t agree with most of what the republicans gave out as a message, because it was stupid and trivial. Which is a shame because if you look deep enough, the republicans did have many valid points that were not addressed. And what still bothers me is such a big law passed via unanimous party assent and dissent, depending on which party you belong to. I don’t agree 100% with either party on health care, but each party represents a very loud voice within this country and to have one large set of voices ignored by the majority party is very distressing to me, no matter how I feel about what those voices are saying. Oh yeah, one other thing I didn’t like: at some point last year, Barack Obama pulled a George W. Bush and subtly changed the discussion from health care reform to health insurance company reform. I really didn’t like that. The insurance companies certainly aren’t angels, but they aren’t the only part that need fixing. The companies certainly don’t deserve the amount of vitriol they’ve received in recent months. But reform is here now, so like it or not, unless it is struck down in the courts or repealed after the next election, we’ve got to live with it, warts and all. I’m reading through the bill as part of my work, so I’ve learned a few things from it. Here’s some things you might want to know, good and bad.
Disclosure: I am a health insurance broker, so I have more than simply a casual interest in this reform law. I was never against reform. I was against the proposed bill in its original form last July when there was wording in it to specifically exclude insurance agents from helping the population make an informed choice. As the bill stands now, agents and brokers are encouraged to help the population with their health care decisions. A big difference.
1. The new health insurance is not free.
Frankly, I don’t know how that one slipped into the American consciousness. Obama never said it was free, no politician republican or democrat ever said it was free. But everyone seems to think they’re going to be getting free healthcare now. That is not the case. You still have to buy the healthcare. And thanks to this new law, there is a requirement that all Americans except the poorest will have to purchase healthcare or face a fine. So if you haven’t added health care premiums into your household budget yet, you had better add it now. Cause you’re gonna be buying it. No ideas on premiums yet, but I don’t expect them to start off drastically different than they are today for healthy people.
2. Large Employers are required to provide coverage to full time employees.
This one could be interesting. Employers could provide the coverage to many, but they might also scale down the number of full time employees they have to avoid paying costly premiums. Also keep in mind the employer is only required to provide the insurance option, they don’t have to subsidize a large chunk of it for you. Premiums may be out of your price range.
3. Premiums may not be so different from today’s premiums at the start.
Again, this one is going to be a wait and see. I’ve mentioned this in prior posts, but it bears mentioning again. Premiums are based on the number of people on a plan vs. the amount in claims that plan is paying out plus a few other minor variables. Despite what Washington has said in this debate, an insurance company really doesn’t get to keep that much in profit. They’re already required to spend most of what they make in claims. Here’s where your premiums will get better: the more people on a plan, the cheaper everyone’s premiums become, because more money goes into the plan. Here’s where your premiums will get worse: more people will use the plan. Healthy people will start to use it more now because they can. And you know those pre-existing conditions everyone was so high-and-mighty about? Well, up to now excluding people with certain conditions have been a major factor in keeping your current premiums down. Kiss that good-bye. In four years, all companies take all comers. Premiums go up as a result? Tough shit. Welcome to the wild world of guaranteed issue medical insurance. And I don’t want to hear the complaint, “I’m healthy, I never use it, why are my premiums going up?” Your premiums are going up because you’re paying for the ten other guys who just came on it that need expensive surgery next week. You get the privilege of paying for it, you lucky guy! So as I said, the balance between increased claims payout and significantly more people on the plans will be an interesting balance as we move forward.
3. The cheapest plan isn’t going to be the cheapest for very long.
Again, this goes back to experience I have with my line of business, so it is a guess, but also a very educated one. If a bunch of people buy their health insurance through this new “exchange” based on price, you’re going to be disappointed in a few years. Insurance companies will start up brand new plans with no claims history on them to brings costs down. As claims come in, those prices will adjust to regular market prices. Your best bet is to do some research, find a plan that suits your needs with a solid company. Find a competent agent to help you with it. I recommend you check with NAIFA or NAHU to find a competent broker if you do not know one already.
4. Networks are going to be much nicer.
I’m trying to find the exact wording in the new plan, but in the original one the House passed a few months ago, they said that every Exchange health insurance plan must accept all doctors and hospitals that are deemed Medicare providers. I believe that carried over to the new plan, but I’m having trouble locating the wording. I’m sure I’ll find it eventually. That’s big. That’s fantastic. That basically eliminates networks and HMO’s throughout the United States. This is one of the biggest overall positives I’ve seen from this entire bill.
5. Death Panels are complete and utter bullshit.
If you’re one of those people that believed the government is going to have a “death panel,” then please stop reading my blog. You are a fool. The government is going to have a “quality assurance panel” that is going to monitor people with long-term medical needs. But you know something? If you are on Medicare, these are already in place. Has the government euthanized anyone yet? If you are on a Medicare Advantage plan, every insurance company has the same set of advisors working for them. If you have major medical, same deal, there’s already administrators working in a hospital for the insurance company to make sure you are getting what you need and the company is not being bilked or overcharged for unnecessary care. If you are on Medicaid, the state has administrators doing the same thing. If you have no insurance of any type, that’s about the only way you don’t have an administrator of some type making decisions on your behalf. If you can pay the bill yourself, you’re in charge. If you can’t, the hospital is going to do everything in their power to get you well enough to discharge you the hell out of there so they can give your bed to a paying patient. It is a system that is been in place since the 1980′s. This is no change.
6. Abortions should have been the least of your worries.
I’m amazed at how the debate misdirected the Americans over to abortions as such an important part of the legislation. The bill encompasses care in a hospital, doctor’s office, clinic, emergency room, employer coverage, individual coverage, Medicare coverage, Medicaid coverage, payments to doctors, clinics, home health aids, hospice, taxes, bonds, levies, state funds, local funds, federal funds, payroll deductions, IRS penalties, premium caps, medical checkups, preventative care, prescription drugs, injectable drugs, drugs in clinical trial, physical therapy, mental health, nursing home, child care, insurance for children, and a crapload more things that I haven’t mentioned. Are you telling me that in all that, the only thing that deserves your attention is if the plan will pay for abortion? Hey, you want to know something? Right now, there’s a 9 out of 10 chance your current insurance doesn’t cover it. That doesn’t stop anyone from getting it. They were never going to cover it in this bill. It isn’t medically necessary. Like any good magician, the people trying to push through the bill just turned your attention away from aspects of the debate that might have an actual impact, both positive and negative, on your own personal lives. Way to go voters.
There’s a lot more in the bill, but it is going to be awhile before I can read through and understand it all. I’ll write more once I know more.
In the meantime:
Sound advice, always
