The ACA/Obamacare is one of the most divisive issues in our history. Because unlike most laws, it’s personal. It’s success or failure is measured individually, any changes can benefit or hurt, person by person. It’s not like a traffic law that is applied equally. This is my view of the issues, there are 21 million other opinions. My job as an HR person is to find the problems and the holes. Personally, I believe the intent of this law was good. But, I also believe the creators got lost in politics, lobbyists and paperwork. They forgot to account for everyone and as each piece was implemented a problem appeared. The new plan was released today. After a deep dive, I’m sure I will create a similar list. This isn’t political, it’s personal for all of us.
- People don’t know what it is. It’s the Affordable Care Act, not Obamacare. It’s a law, not an insurance plan. If you are in America, you are on ACA. (Unless you are on a group plan that is self-insured and your reinsurance is on an Island, but let’s forget about those people for arguments sake. I just know there would be that one comment arguing that I didn’t know what I was talking about.) It’s just like when on COBRA, people say “I can’t afford COBRA, it’s really expensive insurance”. Nope, it’s your plan, you just have to pay the entire premium without your boss giving their portion. ACA is a 2,700-page law that defines what insurance companies must provide and how the government will aid those that can’t afford it.
- You don’t hate the sick or the poor if you don’t love this law. If one more person says “you must have no heart if you don’t believe the sick and poor should have insurance”, they may need to use their deductible from the black eye I give them. I BELIEVE that the sick, the poor and everyone should have access to affordable good quality insurance. My mother died one week before she would have had to go on the State High Risk Pool Insurance. The cost was more than her mortgage. I DO NOT believe that is all the ACA does. There are many unintended consequences from this law. It gave access to the sick and it gave subsidies to the poor, but see #3.
- ACA didn’t fix the main problems. The insurance system is broken. We needed some of the things the ACA provided. But more importantly, we needed to fix the system. We needed to get Rx costs under control. We needed a cap on litigation so your doctor doesn’t give you 75 test for your cold for fear of being sued if he missed something. We needed to get the cost of a band-aid down from $50 dollars because it’s covered by insurance. The ACA didn’t do any of this, they supplemented an already expensive system. COSTS DID NOT DECREASE; the government gave the poor money to be able to be insured (a good thing). But, if you are middle class or on an employer plan, it did not help.
- Age rating! Employers can’t discriminate, that is a good thing. Watch for litigation based on these age rated tables. Currently the difference on the same plan will cost 3x as much for a 64-year-old versus a 21-year-old. The leaked proposal shows the new plan will allow as much as 5x. If you pay a percentage or a flat amount, there will be an employee that will benefit based on how their age. Employers are confused at how to handle these situations.
- How do you budget? Again, the age rated table brings anxiety to employers as we discuss how to handle costs. If an employer covers up to $450 per employee and the 21-year-old costs only $300 and the 50-year-old costs $600, the 21-year-old will ask for the difference in payroll and the 50-year-old will have a significant deduction. If an employer covers a percentage the costs will vary per employee based on age.
- I should be allowed to decide what I need. Insurance is expensive and previously people were able to opt out of certain benefits to limit expenses. Sometimes, people have regretted their decisions. ACA designers decided that we should have mandated benefits on our plans. They added free physicals, certain free screenings, mandated maternity care and many benefits. That Maternity Care really gets me. Pre-ACA, I waived maternity care as I have boys and I don’t have a uterus. I feel I’m educated and adult enough to understand I don’t need to pay for that any longer. When the ACA changed the law, my family cost increased $300 dollars a month, $3,600 per year. I feel I should have been able to make this choice. As I referenced in #3, ACA didn’t make insurance cheaper, so it didn’t even out. It went up and I did not get a subsidy to make up the difference. I was out basically a car payment. I just picture my ghost uterus driving around in the invisible car I’m paying for each month. I hope it’s having fun.
- Individual Mandate. Countless people that can’t afford insurance and are not getting a subsidy have said to me “the penalty is less than the insurance so I’ll take the risk”. I have also seen people jump on when sick and stop paying after they fix their problem. People waive employer paid insurance to be able jump on and off individual plans.
- Premium Costs. I don’t mind that my tax dollars are helping to give the sick and the poor insurance. But I am frustrated that no one notices that the cost of insurance is putting hardship on people, even if they aren’t poor. It wasn’t easy for my family to take a $3,600 hit that first year, wait until you hear about us in #9. There is a big gap between the poor and the 1%, and these people are being ignored in the ACA.
- High Deductibles. Who was the genius that said “I know, we’ll give poor people insurance with $6,000 deductible”? If you are poor, you don’t have that money in the bank and now you are paying for insurance that you can’t use or you use and then can’t pay the bill. The new plan is proposing high deductible plans with Health Savings Accounts. HSAs are not helpful to the poor and sometimes to the middle class. This year our family is paying $900 per month AFTER an employer contribution for a $5,000 deductible plan. I made medical decisions based on that already this year. I’m hoping that I stayed off my foot enough for my self-diagnosed stress fracture after a google search. I decided that since they don’t cast and suggest rest, I wasn’t going to spend $2,500 on an MRI. Time will tell if that was the right decision.
- Insurance Companies. I have zero affinity for Blue Cross, ZERO. But they are soon going to be the only player in the exchange. Insurance companies are jumping ship as the people are gaming the system. Don’t get me wrong, I know they are making money and they do some awful things to get out of paying claims. But that’s because we didn’t fix what needed to be fixed (#3) and they can do whatever they want without consequences.
They just released the Replace part of the “Repeal and Replace” plan. It’s worrying me, again I think they are missing the point. They are concentrating on the cost of the premium and the tax credits and not the system. Prescriptions shouldn’t cost less in Canada, I shouldn’t be able to sue my doctor for $10 billion dollars for a bruise and I should be able to decide if I want to insure my nonexistent organs.
I hope we can find a way to do the right thing for everyone. I hope we can have a conversation without assuming wanting to make changes means you hope people die in the street. I don’t think anyone feels that way and I hope we have enough respect to listen to everyone’s personal story.