My Experience and Opinons on Obamacare

health reform

The mere mention of the words “ACA” or “Obamacare” can start a flood of comments. There doesn’t seem to be a big middle ground as people are either in support of it or vehemently against it.

As someone who was already getting private insurance before the onset of Obamacare, I can give you my first hand experience and impressions about it.

I was also one of the privately insured who received a notice that my insurance would be cancelled next year due to changes in the health laws. Like others, I was also surprised and not expecting that. I had assumed that I would have a choice to pick a plan under the ACA or stay with my current plan.

Obama took tons of heat from people angry that their insurance got cancelled despite his promise that folks would be able to keep their plans if they want. The thing is, it seems to me Obamacare isn’t the reason the plans were cancelled, as in they were not “ordered” to close, but the insurance companies are using it as a reason to get rid of them. Here is where we see the law of unintended consequences coming into play.

The new law makes it mandatory for everyone to buy insurance. The insurance companies know this. Therefore, they now have a great incentive to get rid of their cheapest plans knowing that they have a guaranteed market of buyers. Now an argument can be made that the Pres and Co. should have realized this would happen and therefor can still be blamed. This is an unfortunate consequence of creating forced demand.

So my next step is to see what is available on the new ACA health exchange. Fortunately I live in California, one of the states that created their own separate exchange so I didn’t have to deal with those huge problems the Healthcare.gov site had.

I guess I should discuss my thoughts about the Healthcare.gov kick off debacle. They blew it- no excuses. Simple as that. I’ve worked on many IT/software development projects and it’s clear the website development team were sorely lacking in organization and accountability. That said, this is how things work – ideally, the company knows in advance how much time is needed for a project by discussing it with their engineers. In reality, many companies just pick an arbitrary date and expect their team to work overtime or do what it takes to get it done. The “reality way” sucks, and is the reason many people wonder why they choose the engineering/IT profession with all the late nights and weekends spent at work.

The next problem is the “moving target” of scope of work. In the beginning there is a cloud of confusion as to what needs to be done and that chews up time. Then finally a plan is developed , and as more information comes in the plans can change dramatically, negating much of the work that was already done. You can be sure that plans were changing constantly with a project of this scope and size. This also consumes lots of time.

At the congressional hearing on what went wrong, they also mentioned that they only spent about two weeks doing end to end testing. This is a joke as even small projects can require months of full testing and one of this size would need far more than just two weeks.

Those in charge should have delayed the start by a month or two and taken the heat from it. The next alternative was to open it to just a few states at first before making it nationwide. Instead they just let it start as scheduled and “hoped” for the best. Terrible decision. It would have been far better to be embarrassed by a delayed start than a software fiasco that makes everyone involved look like dunces.  It just gives all the opponents that much more ammo to attack with. There clearly needs to be accountability for the decisions made.

Of course it also needs to be said, the web site is itself not “Obamacare” and a problem with the site doesn’t automatically equate with the law being a failure, despite what all the detractors say. We won’t know if it’s on track for success or failure for at least a year or two.

Okay, so I get on “CoveredCalifornia” via the Cali health exchange and see what I have to do to get insurance.

The required information includes entering my social security number and expected salary for 2014 as well as any known deductions. From that they determine whether one is eligible for Medicaid or ACA coverage.  This is a HUGE difference from what was needed for private insurance pre-ACA. The forms I had to fill out before required me to fill out pages and pages of medical history, naming any and every doctor I’ve visited, where they worked, medications taken, procedures done, results of all actions over the last several years. When filling those forms out you were always under the gun to include anything and everything medical because the form also stated that failure to include ALL medical details would be cause for insurance cancellation.

There have been proven cases where someone came down with a serious chronic illness and needed ongoing expensive treatment, and then shortly thereafter, their insurance company researched their past medical records and cancelled their insurance because they failed to write down they had acne when they were a teenager. This is what most people worry about in the world of private insurance – getting cancelled when you need it the most for some spurious reason.

So the easy form to fill out is an immediate plus to me, as well as the fact that I know I can’t be kicked off my insurance or denied as a result of companies trying to cut costs.

Now I get to choose from the insurance packages being offered and compare the new prices to what I’m currently paying under the old private system. My current insurance is known as “catastrophic”, meaning that I will pay for all medical expenses until costs exceed the deductible which is about $5K, then my insurance covers everything else. However, the yearly check up and vaccinations are included and the deductible is waived for those. The high deductible allowed me to get lower cost monthly payments.

I can opt for this since I haven’t required many visits to the doctor and am counting on the trend to continue. Now some who are unfamiliar with insurance might argue why am I willing to pay for insurance when I still have to pay for medical expenses up to five thousand dollars. The answer is risk management – I’m only risking a maximum of $5k in medical expenses per year versus my life savings and assets if I should get seriously ill or injured and require medical treatment exceeding $5k. For those unfamiliar with medical costs, I had to go to the emergency room once, and I saw my insurance (full coverage at the time and not private) paid out $11K to the hospital. That’s just one visit. Extended stays in the hospital and surgery can run into the tens and hundreds of thousands of dollars. By not being insured properly, one is risking their financial livelihoods.

The new private insurance plans now being offered runs more expensive than my current plan, but they also include a lot more coverage. A visit to the doctor now has a fixed lower cost for the first 3 visits, as well as emergency room, urgent care, and other operations like x-rays. My out of pocket expenses now have some cushioning. My total deductible is now higher at over $6K, but the fixed lower costs of visits and procedures more than make up for it. Knowing the costs in advance makes it easier to figure out expenses than the unknown of what the costs would be. In the past, I’d try to call to get prices of doctor visits out of pocket, and no one would know the answer- or at least they kept their lips sealed- so there was always a worry a trip to the doc would be big bucks.

I selected my plan, and the first attempt to finalize failed as the system output an error message. The data was saved, so I tried again, and got the same error message. I was going to call, but I figure I’d try a day later first, since my data was saved with my log on account. When I tried it the next day, success!

So overall, the process of signing up wasn’t that bad at all, and in my opinion, the benefits of the new system are great and much superior to the much more complicated multiple page medical information required under the old system.

Another argument I’ve been seeing online that makes no sense is that doctors will reject insurance under Obamacare. It makes no sense because I’m buying private insurance under the system, so there’s no way any doctor can tell how your insurance is obtained. The argument is really referring to Medicaid, which is different, but folks are conflating the two either by mistake or deliberately as a false attack.

The software glitches will eventually(hopefully) be fully resolved and then the real proof will be if costs are controlled.

As an entrepreneur, I think this new system is great because it finally lets people get decent private insurance at more affordable costs. The biggest fear most people have with leaving the office job and striking out on their own is the loss of insurance benefits from their company. The ACA removes that problem.

Coming down with a preexisiting condition like diabetes or cancer meant you were trapped to the insurance company you were currently with, and if they kicked you out or left your state, you were out of luck. Now you have a full selection of insurance companies to pick with no fear of rejection due to a preexisting condition. This is also a huge plus.

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6 thoughts on “My Experience and Opinons on Obamacare

  1. From a medical perspective here is one of the biggest issues frustrating medical professionals today. When a doctor bills the insurance company, it’s often quite expensive. To have a colonoscopy for example – the bill may be about $800 + the costs of other fees. It’s not an entirely unreasonable sum, as doctors do have to make a living. Consider the fact that they also have to have high insurance costs themselves, malpractice ect, as well as the costs of paying their staff, equipment, loans, and other dues. When they bill an insurance company, I hate to say it, but you’d think that they would get at least a fair return of payment. Not so. In fact, it’s rather shocking to see how little insurance companies will offer them. With more people insured, this means that doctors have to make a choice in their practices. They must take the insurance and make less money for their services, or they must refuse all insurances and profit. That is the medical community’s current concern. More people insured = less payout for services = less pay for employees. Additional issues have also arisen. Some hospitals (I will not name them here) have barred, yes barred, their employees from seeking any outside insurance. They must only use the insurance offered by that hospital, may only see a doctor within that hospital group, and may only go to that hospital for emergency care. Thirdly, some have found, especially in smaller towns, that with these newer insurance models, they can no longer see the same doctor they have been happy with for years. As it turns out, you can only go see the doctor covered within the network, forcing many to make difficult choices of where to go. Take Kaiser for instance… when they first launched in the eastern US, doctors at my practice were the only specialist in the field to accept that insurance. They had massive influxes of patients coming from all over the United States to see them, as they were the only doctors listed. This caused long waiting times, conflicts, and overall they were not always able to see everyone. Another issue, don’t always assume that because you have insurance, that ER doctor will be covered. I have seen too many times a hospital claim they take your insurance, but the actual ER doctor does not, meaning you end up paying most of the bill anyway. Lastly, insurance companies constantly put up a fight about covering perscriptions people need.. sometimes even critical medications. When you have to fight for months with an insurance company to cover something expensive, and you desperately need that medication — this particular issue will increase the more people have insurance.

    I certainly agree that since insurance companies were offering substandard insurance that it’s keeping with the law that better ones be offered. But better services means additional cost to the consumer. The insurance companies don’t want to seem the bad guy. They’ve tried very hard to make it seem like their hands are tied. But the reality is, they could have sent the cancelation notices along with notices that they have better plans and options out there.

    For the record Maryland’s exchange is a mess right now. I’m glad yours is working at this time.

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    • I’m not sure I understand part of your concern regarding insurance payouts and doctors profitability. Are you saying that doctors have a choice not to take insurance to be more profitable? If so, that would depend on the non insured person having enough money to pay for the costs. There are many people who would be unable to pay even just the amount the insurance covers. Those without insurance will also be quickly dismissed from most hospitals unless it’s proven to be an emergency situation.

      Of the big three types of insurance, HMO,EPO, and PPO, HMO’s and EPO’s are the most restrictive – limiting you to doctors in their network to be covered by their plans. They also have the lowest pre negotiated rates of payout. I think your biggest concerns have to do with these types of insurance.

      I have personally suffered enough when having HMO insurance with the runaround and trouble, that I avoid them like the plague now. Some folks have good experiences, but two of my worst experiences have been due to HMO policies.

      PPO’s offer the greatest flexibility in see the doctor or specialist of your choice, but they also run more expensive with more out of pocket costs.

      I agree that HMO’s/EPO’s mandate lower rates of pay and in response some doctors would rather avoid that type of insurance. I’ve had it happen to me when I scheduled a doctor visit only to have him become “unavailable” once he found out I had HMO insurance, even though he was under contract in my insurance group.

      I would say there needs to be an independent arbiter to determine true pricing so that payouts won’t be inflated or deflated.

      This is also why the public option was/is sorely needed- to establish a floor of medical treatment. Even if public option service wasn’t stellar, it would be at least something for those who can’t afford more expensive insurance and far better than the choice of not having any timely medical treatment.

      The insurance companies win by getting more customers to pay for insurance, and they can also blame any cost increase on “Obamacare” despite the fact that prices have been steadily climbing for years dating back to when the ACA concept was still warmly embraced by the Republicans in the 90’s.

      The ACA is far from perfect, and will undoubtedly bring some new problems to the system along with its benefits, but at least it opens the door to fixing the problems like the ones you addressed. The old system was steadily deteriorating year after year with only talk but no action of how to fix things.

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  2. Yes doctors do have a choice, and many are choosing to take their chances and increase their profits by no longer accepting insurance or limiting them. If insurance companies actually paid good amounts back for services rendered, I feel that doctors would almost be thrilled with the ACA. You may argue that a poor person may not be able to pay the doctor his amount anyway (at this point we have a hard enough time making people pay their simple co-pays), but ethically most good doctors and hospitals will not refuse to care for that patient. They have an oath to care for the ill and an ethical obligation to their employees and practices to try very hard to stay in business. But I would also argue that many hospitals do in fact squeeze the uninsured quite hard to get their returns, because they know at least the honest will try and pay their bills off or face collection. Many times in my life I have been uninsured and racked up high medical bills. They got paid off slowly, but the hospital and doctors never refused to treat me. At the same time, if more doctors refuse to take insurance — we start to have greater wealth and income disparity. The rich who can afford to pay the doctor’s bill may end up getting care first before the poor. You will find, in the UK system of the NHS, that many doctors operating outside the spectrum of the system (private practices that do not participate with the single payer system) do quite well for themselves — mainly because the clients that come to them, can afford the care.

    And you are right PPO’s come at greater cost to the consumer. And this is why I feel a poor person will not take that as an option. A friend phoned yesterday (as her insurance had sent one of those letters) and she signed up to a plan with the ACA. She quickly discovered that while it offered lower cost, it would not cover ”name brand” drugs. Maybe this was in the fine print on the description for the insurance. Surprisingly, some generics do not work as well as their counterparts. She ended up having to choose a more expensive plan. The savings was negligable. It just turned out to be a frustrating experience, rather than one that was clear and offered a sense of security with a ”better plan”.

    With more people mandated to obtain insurance (or take the penalty) we will still have an increase of individuals fighting to get medications covered with prior authorizations. Nothing in the ACA helps to address this issue. Doctors typically understand the ethical implications and are frustrated with insurance companies lack of compassion vs cost. Some doctors kindly offer samples to patients and to the poor in an attempt to help them while waiting endlessly. Unfortunately drug companies, such as GSK have fallen under heavy pressure to stop promoting drugs to doctors. GSK will now stop handing out all samples by the year’s end. In Maryland we now have a shortage of sample drugs, which is leading to stockpiling and stuggling of how to help patients.

    Having public options, is something I don’t have much of a problem with — however, if we did utilize such a system here the sheer cost is something that the public could not manage. Americans hate taxes. The British are not ‘fond’ of them, but acknowledge a greater good begrudgingly. Until that mindset changes here, single payer will not fly. The American people have little trust in their government, I am not confident myself that the ACA will work as intended — and every election cycle will come under threat. To me it doesn’t feel as effective as it should of ever been. It feels like we’re settling for something that only puts a band-aid over a festering wound, instead of treating the infection.

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    • The main problem today certainly isn’t too many people are being insured. The top reason for bankruptcies in the US is due to people being overwhelmed by medical bills. This comes from not having insurance, followed by those who don’t have adequate insurance that provides enough financial support.

      The majority of pay doctors receive are from those who are insured versus those who pay out of pocket.

      To not be insured is to risk financial ruination. The poor need not worry because they can go to the emergency room and can’t be refused by law, despite the fact that getting treated by the ER is one of the most expensive areas of care. Then when the bill comes, they have the option to ignore payment or declare bankruptcy. Those who have little have little at risk.

      The wealthy can afford the risk of a big financial hit from not being insured- as long as the illness or injury isn’t too catastrophic.

      It’s the middle class type person who has some assets like a home or retirement savings, but is far from wealthy that will pay the greatest costs from not being insured. They won’t be able to easily escape bills via bankruptcy because they do have assets that can be seized or liened.

      You may have had to pay your own bills when not insured, but what is your definition of high? There are medical events that can wind up costing you amounts to go into the high 5 figures or even over $100K. If this condition turns out to be chronic requiring expensive treatments or drugs, that high expense becomes an annual event.

      Many doctors may be ethically inclined, but they are also likely swamped as it is with their current load of patients to have the time to worry about the additional uninsured, who may not be able to pay their medical bills. By law they have to treat emergency cases, but the average person walking into the hospital or doctors office trying to get a check up without insurance or up front cash/credit card is unlikely to make it past the admin desk to even make a case to the doctor in the first place. Being unable to get preventative medical attention is another reason why the poor have a shorter life expectancy as they can’t get screenings to detect major ailments like cancer, and by the time it becomes known or an emergency situation subject to treatment, it’s often already too late to make a difference.

      The options in the ACA exchange should mirror those available in the private insurance market not in the exchange. The main difference is the government is offering subsidies to lower the cost of the ones in the exchange to help with affordability. For your friend, she would have the same insurance options outside of the exchange without the ACA for varying policies that also have varying coverage.

      Getting prior authorization for certain drug prescriptions is a policy of HMO’s and EPO’s, a specific type of health insurance, rather than insurance policies in general.

      GSK and other drug companies are under pressure to stop promoting drugs to doctors due to their undue influence over them in getting doctors to prescribe more expensive medicine for bigger profits to Big Pharma, without regard to the true benefit to or safety of the patient.

      Big Pharma is the reason most of the drugs prescribed remain at sky high prices.

      Here’s another link showing their influence over doctors:

      http://www.cbsnews.com/news/mega-bucks-flow-from-drug-cos-to-doctors/

      The corporate pharmaceutical giants care more about their profit margins rather than helping those in need obtain affordable drugs.

      I agree that the ACA needs work and improvements, but at least it’s a start. It’s amazing it even got this far with only half of the government supporting it and the other half trying to stop or obstruct it in any and every way they can.

      The bigger problem is the Republicans are offering no solutions other than to scrap the plan altogether. That’s really no solution at all. Both the Republicans and Democrats should be working together on fixing the problems rather than playing politics.

      The rich will always have access to better heath care. As you stated, the PPO type of insurance policies run more expensive, but that would still be the case if the ACA never existed.

      I can tell you personally that ending the lifetime limits cap and no more preexisting condition exclusions are two key benefits the ACA brings that remove much of the pain/fear from the private insurance market. The government will need to work as a whole to solve the bigger problems of cost control and HMO,EPO policy restrictions.

      My guess is we won’t get much bipartisan effort on this until the midterms are over next year- which will again be framed as a mandate of the people to accept or reject the ACA.

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  3. Just to add about GSK, I’m aware of the current reporting of their status and claims they are doing it because of ”pressuring doctors”. That may be true in some instances, but I can tell you the policy chage is going to have far reaching consequences as I have described. Take it as a little ‘inside’ information here. They will no longer be bringing in samples to doctors and this is having an effect on how much they can assist their patients that need those drugs. I can tell you that some representatives will even be losing their jobs because of it. There is a shortage and we’re worried about it.

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    • Here’s a list of Big Pharma’s biggest civil/criminal penalties:
      http://projects.propublica.org/graphics/bigpharma

      As you can see, bad/unethical behavior runs across the board for all major manufacturers.

      In particular, I blogged about an egregious Glaxo incident regarding mislabeled and adulterated drugs in 2011:

      http://soullfire.xanga.com/2011/01/09/glaxo-pharmaceutical-exposed-choosing-profits-over-known-human-safety-risks/

      The lack of concern of the patients/customers vs their concern over the bottom line is appalling.

      The coming shortage of drugs due to the change is exacerbated by the main weapon most big conglomerate entities use when anyone threatens their status quo livelihood – corporate strike back. They make “adjustments” within their sphere of control to make things worse for their customers, and then blame it on those forcing them to make changes. It happens in every industry. When banks were stopped from charging excessive interest rates on people not savvy enough to choose a better card rate plan, they raised, fees in other areas, ended most free checking plans, and blamed it on “excess regulation” costs.

      A more current example is the behavior of the insurance companies cancelling their cheaper policies that they didn’t really have to, raise their rates, and then blame it on the new ACA.

      Corporations in power love maintaining their profits through the status quo and aggressively counter attack any perceived threats.

      In the US the cost of prescription drugs can be as high as 6X the cost of the same non generic drug sold in other countries. If US prices were more reflective of the world market rather than the artificially inflated one here, the need for free samples due to lack of affordability would be much lower.

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