The Unaffordable Care Act

   Anyone looking in on the United States could not fail to be confused by what we present as health care. As a citizen, I am not only confused, but also frustrated, upset, angry, and trying not to go broke. Once upon a time, having lived under a good coverage umbrella provided by employers at a reasonable cost, I didn't realize there was a problem. I recognized that there were issues for those who did not have my good fortune, but in my fairy-tale world, our country had taken measures to help eliminate this problem.

Some fairy tales don't have good endings.

   Reality reared its ugly head when my family no longer lived in this warm and fuzzy chapter of our health insurance book and had to move into the sequel of our health care arrangements. That is where we have learned the long, hard and expensive lesson that health insurance is not equivalent to health care. And the term Affordable is a relative term.

   For those yet unversed in this alternate universe, health care insurance in America goes by many names. Group health plans (or employer health insurance) is the name often affixed to insurance coverage provided by companies for their employees and families. An extension of this coverage is COBRA (Consolidated Omnibus Budget Reconciliation Act) that allows families and individuals to continue their workplace insurance for a limited time after employment ends. This can be helpful if you are in the middle of a treatment and wish to continue on your plan, but it is at full cost to the individual and their family and can be quite expensive. The Patient Protection and Affordable Care Act (usually referred to as Obama Care) created the open insurance Marketplace. Through the market place various private health insurance companies compete for business to provide insurance to individuals and families who do not have coverage through their workplace. If the individual or family is eligible, they can also apply medical tax credits against their monthly premiums.

   Still with me? It doesn't end there. For those of low income or no income and folks who qualify for Supplemental Security Income, there is Medicaid, an insurance program managed directly through the government.  Seniors 65 and older and those who qualify for Social Security Disability Insurance may enroll in Medicare, another government managed program. (Mind you, SSDI recipients are not eligible for Medicare until two years after their SSDI entitlement.)

    In addition there are also Health Cost Sharing Groups like Christian Health Care Ministry, Samaritan, Medi-Share and Liberty HealthShare (to name a few) that can provide options for medical benefits currently required by law. Some of the latter types of coverage might also be found under the title Medical Cost Sharing groups.

   Add to this quagmire different types of healthcare insurance options offered such as HMOs (Health Maintenance Organizations), PPOs (Participating Provider Options), EPOs (Exclusive Provider Organizations), and POS (Point of Service) plans.

   Now remember, your doctor or treatment facility of choice may or may not accept your insurance and can choose to refuse treatment based on what insurance coverage group you have - except in the case of emergency room visits. But beware, if you are admitted to a hospital that is out of your network you may incur additional charges for the duration of your stay. You are expected to be a savvy consumer, not just a patient following qualified medical advice.

Does your head hurt yet?

  Take some aspirin. There's more. Each type of insurance has its own rules and covers these options in different ways. In addition, each individual insurance company has different levels of coverage under each one of these categories. All this depends on what you can afford to pay in premiums, deductibles and out of pocket expenses. While laws enacted over the last few years have stopped insurance companies from refusing to accept preexisting conditions or placing dollar caps on coverage, it has not prevented them from raising the premiums, deductibles, or those pesky out of pocket expenses.

   Per the original expectations, insurance premiums on marketplace options in my area were expected to increase about 25% in 2017. What we saw was a 55% increase in premiums. And raised deductibles. And increased out of pocket expense. Moreover, there were less insurance plan options to choose from. Did I mention that many insurance companies have decided to ditch participation in the marketplace?

Most of us now just call it what it really is. Unaffordable.

   So why aren't Americans jumping to repeal? 

   Maybe because there are approximately 18 million people who wonder what they would do for health insurance next year. Right now, I am one of them. After all, no one has seen an alternative plan offered. Perhaps the estimated 27% of adults under the age of 65 who have preexisting conditions are beginning to worry about the future of their coverage should the law be repealed. Could it be that women in the United States (about 51% of the population) want preventable health care benefits without being discriminated against as they were before Obama care? Possibly we have been numbed to the point of submission.

Who knows?

So for those of you watching the United States and wondering about the madness here, there is treatment for that...but no one can afford it.

   Sources: Health Care Acronyms; ACA coverage number-potential losses; Preexisting conditions estimate; Preexisting healthcare demographics; Number of women in United States; Census data