Bottom Line Up Front: The protections gained under the ACA must remain available to everyone and the flaws must be fixed.
There has been a lot of talk about healthcare lately, and with good reason. People’s frustration stems from the rising cost of healthcare, plus the rising cost of insurance to cover it. In order to understand the solution, let’s take a look at the problem.
Imagine Phil, a 26- year- old, part time student with no insurance. He has a toothache, but no money to take care of his sore tooth. He waits until he passes out, and someone calls an ambulance. He goes to the Emergency Room and finds that he has blood poisoning which requires a week in the hospital. A simple visit to the doctor, which would have cost Phil $25 in a co-pay (if he had insurance) now costs $25,000 in hospital and ambulance expenses. If Phil did not have the money for health insurance, he certainly does not have the money to pay $25K to the hospital. So, Phil defaults on the debt. In an attempt to recoup some of the costs of caring for Phil, the hospital passes the unpaid expenses on to other patients in the form of increased fees for services, which causesing everyone’s insurance rates to go up.
Let’s think about someone else. Sally is 45, widowed, with two kids. She works two part- time jobs, but can’t afford insurance. Sally is diagnosed with cancer. Her condition today is only at Stage 1, which means it’s likely curable, but she can’t afford the treatment. Eventually, she will be hospitalized for the condition when it is far too late to cure. The cost for treatment may be over a $1 Million plus possibly her life.
The Affordable Care Act (ACA) provides several protections for Americans, among them:
•People cannot be denied coverage because they’ve been sick before. If you’ve had cancer, were pregnant, or changed jobs, you can’t be denied coverage because of your pre-existing conditions.
•People under 25 living at home can remain on their parents’ insurance plans. This means that young people just starting out do not have the additional expense of trying to afford health care on while going to school or trying to get a job. That’s, of course, if their parents are able to afford coverage themselves.
•There is no ‘Lifetime Cap.’ Lifetime caps are something insurance companies used to cut their losses. Lifetime caps make great business sense, but they are terrible for patients. If Sally is in the middle of treatment when she reaches her lifetime cap, the insurance company will cut off her benefits. This may mean she can’t complete her treatment. And, since our friend Sally she had now has a ‘pre-existing condition,’ no other insurance company will touch her. The ACA did away with lifetime caps, which means Americans like Sally don’t have to worry about having their treatment stopped because of some made up financial limit on their policies.
•Insurance companies now have to spend a certain percentage of the premiums they take in on the people that buy the insurance. Previously, insurance companies had every reason to deny you coverage, because if they could find a way not to pay, they made more money. Under the ACA, insurance companies only make more money by being more efficient, not by denying you coverage.
•Insurance companies must include certain items in their coverage. For example, if you go to the hospital, and it turns out they treated you for the wrong thing (or it gets worse), the insurance company would have to consider it a single event. This means you only have to pay one deductible, and hospitals and doctors would not get a second round of payments. Under the ACA, caregivers have an interest in getting your care right the first time.
• If you don’t like your employer’s health plan, you can get your own.
•If you cannot afford insurance, there are government subsidies to make it affordable.
What some people do not like about the ACA is that it requires everyone to get to have minimal healthcare. Requiring people to purchase coverage ensures that it is as affordable as possible. It’s like a co-op buying a tractor, the more people that go into the co-op, the less each person pays. Even if they have to get a bigger and faster tractor, they pay less per person by splitting the cost.
Are there problems? Sure. Adjustments need to be made to the plan. Some people, though a significant minority, had to pay more for coverage. That needs to be fixed, and it can be, if both sides of the aisle are willing to work with each other.
The fact is *everyone* in the United States gained at least some protections under the Affordable Care Act, and those protections MUST stay in place.
What does the ACA cost the average person?
• A 30 year old making $25k a year pays 6.8% of their income, or $142, a month.
• A 30 year old making $25k a year with 1 child pays 4.36% of their income, or $91, a month.
• A 50 year old making $50k a year with a spouse pays 6.09% of their income, or $254, a month.
Want to see what your numbers should look like? Go here: Insurance Calculator There is also an option to calculate what the most recent proposed Health Care Plan would cost people. The creators of the insurance calculator pledged to post cost calculators for any new proposals so you can see how you will be impacted by what Congress proposes. Consider bookmarking that site.
Want more details on what the ACA does for people, and what it doesn’t? Look here: Health Power Information
Why do some people call the ACA an ‘Entitlement Program’? Because the government is subsidizing the cost for the poorest among us so that what the percentage they pay is a similar to what others pay in terms of percentage of their income. That way the insurance companies get the money they need to operate, and the poorest Americans get the coverage they need. The very best way to reduce the need for the ‘Entitlement’ is to raise the average income to lift people out of poverty, not cut their access to healthcare. Look for more information about living wages under ‘Income Inequality’.
Consider reading Matthew 25:31-40 to clarify why we value supporting others.