The Affordable Health Care Act

I have tried to avoid this one as I strive to stay out of the emotion filled political issues and instead look at other issues like my last post on Medicare but as I finished writing that one, I received some information in the mail from Blue Cross that I felt had to be commented upon.

I received a package entitled “Health Care Reform is Coming”. It does on to state - Health care Reform will be different for everybody. (I thought it was going to equalize everybody.) So here it is. (I am adding my comments in a different color so you can tell the difference between what they said and what I say)”

Some of the benefits already existed, so new or expanded benefits are listed in bold:

• Ambulatory Patient Services
• Emergency Services
• Hospitalization
• Maternity and newborn care not automatically covered.
• Increased benefits for mental health and substance use disorder services including behavioral health treatment.
• Prescription drugs.
• Rehabilitative and habilitative services and devices.
• Laboratory services.
• Preventive and wellness services and chronic disease management.
• Pediatric services including oral and vision care.

< So if I am not insane (hope not), just born or a child (hah), or expecting a child (blow my brains out at this point in life), then I really don't get anything. >

Additionally, all new health care compliant plans now have an annual cap on out of pocket expenses (estimated $6350 for single and $12,700 for family).

< Oh joy! $12,700 is all I will have to spend out of pocket AFTER I pay for the premiums! With premiums close to $1000 a month now and $12,700 out of pocket I won't have to worry about house payments or groceries anymore! Get real who can afford $24,00 a year in insurance premiums AND out of pocket expenses? I thought this was the Affordable Heath care Act, not the Run Them into Bankruptcy Act. More on money and premiums and money in a moment. >

Terms defined:

Federal Poverty Level (FPL) – A measure of income level (by family size) that determines eligibility for premium tax credits. For example, a family of four that makes less than $94,200 a year may be eligible for help.

< Moment is here. $94,200 is poverty level for a family for four!!??? It that is poverty I am buried in poverty. The news reported the other day that the average (not median) income in this country is approximately $55,000 a year. That means before taxes half the people in this country earn less than $55,000. After taxes that means half this country has a take home of about $38,500. now subtract the $12,000 on insurance premiums and the $12,700 in out of pocket expenses and you have about $13,800 to live on (food, gas at $4/gal, house note or rent, etc.). If you make less than the average income as half the country does, then you have serious problems. >

Premium Tax Credits – These will be made available to low and middle-income Americans and applied to health insurance premiums. Cost Sharing Reductions will limit a plan's maximum out-of-pocket costs.

< If poverty for a family of four is $94,200 a year, then what on earth is low to middle income? Low must be $100,000 - $150,000 and middle income must be $150,000 - $250,000 a year. Nice to know they will be helped also. Does anybody know the Great Recession is still impacting so many Americans? We cannot afford this! >

What Are My Options?

One of the things you will need to do is determine if you have a grandfathered plan (which refers to health insurance plans that were in effect prior to March 23, 2010).

< So if you changed jobs or got a new plan after that date, you will be forced to change with no options! >

If you have a grandfathered plan:

You have flexibility. If you like your current plan you can stay with it. For many people, this will be the best course of action because it may be the least expensive option.

< Key words here: Least expensive option. Meaning the new Affordable Health Care Act will cost more than anything we have now. I thought this initiative was to help people have insurance that could not afford it. This sounds like if you can't afford it now, you really won't be able to afford it later!! >

You may still qualify for a premium tax credit that can be applied to health insurance premiums; however, premium tax credits cannot be applied to your current grandfathered plan. It may be in your best interest financially to stay with your grandfathered plan.

< In other words, it is going to be really expensive. The tax credits will NOT begin to cover the additional cost and you better stay with the grandfathered plan. BUT WAIT, what about those that did not have their existing plan on March 23, 2010? What if you moved or got a new job or some other way had a life change that moved you to a new plan? Buckle up, here it comes! >

Once you leave a grandfathered plan, you cannot go back to it!

< Oh, so if your children grow up and move out or you get a new job, you have no choice, you will be forced to move to this new insurance coverage!! >

If you do not have a grandfathered plan:

We will automatically move you to a 2014 BCBS health care reform compliant plan that most closely matches your current plan. Your new plan will look a lot like what you have today. You always have the option to change this plan during the annual open enrollment period.

< Really? Really? When is the last time your insurance plan or anybody else changed you to a new plan or anything that was better for you? I had a friend that had a computer replaced under warranty with the assurance that it would be as good as or better than the one it replaced but they got no say so in what it would be like. Well, let's just say they would up buying a new computer as it was so unusable. Among other things it was supposed to be for a female to carry to class. They had a 15 inch laptop and got a 17 inch thing that weighed 10 pounds (literally 9.6). The point is if you believe you insurance company is going to move you to a plan that will cost about the same and have the same basic coverage, I have property in the Florida swamps to sell you and a bridge in Brooklyn also. >

< My Bottom Line: It appears one of the largest financial disasters this country has ever experienced is about to happen. This will be so much more than the dot com bust in 2000 or the housing bust, or the Great Recession. I don't want to sound like a fear monger as I typically heat that but when I look at the numbers ($94,200 poverty line, $12,000 for health care premiums currently with significant increase to happen according to the insurance companies, and $12,700 out of pocket expenses, I don't see how the working class will survive. I suggest you get you application in now for government housing, food stamps, and welfare. The line forms to the rear, don't get caught short. >  

** Update: The news reports that the government has allowed business a one year exemption to the Affordable Health Care Act. If business have a one year exemption, why can't individuals get a one year exemption? (or more). If businesses don't have to provide the coverage the plan requires, does that mean that the employees will now have to buy it out of pocket like so many others? This doesn’t help matters, it only puts more of a burden on the people.

The Act has already hurt so many people by encouraging companies to limit their workers to 30 hours a week or less. If you don't believe this, go talk to anybody that has tried to get a job or has gotten one in the last few years. Odds are they are at 30 hours a week or less.