WC Varones

Don't lend your hand to raise no flag atop no ship of fools

The brighter side of Obamacare

Though the most visible effects of Obamacare are millions of Americans losing their health insurance and higher health care costs for almost everyone else, it's important to remember that there are some people who are actually helped by Obamacare.

One such person is a Facebook friend of mine. "Sue" is not old enough for Medicare, but old enough to be in the deep end of the risk pool. She didn't have insurance prior to Obamacare because it was simply too expensive in the individual market. Under Obamacare, she has been able to purchase a heavily subsidized plan that costs her very little. Here is Sue's story :
WC, I couldn't afford coverage. [Husband] "Bob" had it through Veterans, as he's a Vietnam Vet. I was able to get subsidized Healthcare through CoveredCA.com. California had a better system than Healthcare.gov. My first appointment is Jan. 7. I was able to get a primary care physician here in Encinitas. My doctor is on El Camino Real. I had a small glitch because I switched to her from another doctor in Oceanside. I got to request a woman doctor, and there were several under HealthNet, my new insurance provider.

My daughter, who was insured through her and her husband's private corporation, which later went public, was dropped by her insurance carrier for various reasons, but mostly because she got thyroid cancer; her cancer was diagnosed and removed, but then she had to get a different, much more expensive insurance company and they would not pay for anything related to her pre-existing condition. Fortunately, "LeeAnn" has been in remission for more than five years. However, both my daughters are glad I'm now covered, and will be getting a check-up, at long last.

I was surprised I got an appointment so quickly, but I really worked at signing up in a timely manner. I did have to wait on hold for over 10 minutes a couple of times.

Our next door neighbor, who works, but not enough hours to be covered through her jobs, I think, was able to qualify for subsidized healthcare premiums of only $41 per month. She and her boyfriend/now husband are very glad for this opportunity, as am I.
Observations:

1) So far, so good.

2) This anecdote supports the proposition that older and/or sicker people are much more highly motivated to sign up than the young and healthy, especially with the program subsidizing the old and overcharging the young. The one young uninsured fellow I know hasn't bothered to sign up and is offended by the whole program.

On the sign-up process, choices available, and costs:
Yes, one could choose between bronze, silver and gold, bronze being the least expensive. But because Bob and I are both retired now, and on a low fixed income (Bob recently turned 65 and is now also on Medicare, so he doesn't need to sign up for this coverage).

But the years between 60 and 65 are considered high risk by insurance companies, and those are the folks that get charged the highest premiums. Depending on what plan I selected, I had to pay for a "Silver" HMO coverage up to $91 per month. I signed with HealthNet, for the lowest amount, but I am not affiliated with Scripps hospitals. I'd rather not say exactly how much I pay, but it's less than my neighbor, at $41. Remember, this is for one person's coverage, only, not family. The government is paying the insurance company around $600 per month! What is outrageous, to me, is that the insurance companies are making so much on this deal. I say it's a far better arrangement for them than Medicare or MediCal [California's Medicaid]. We would not have qualified for MediCal, in any case. If someone is indigent, say homeless, that person could get MediCal, already. But those people usually wouldn't sign up, and would be "processed" through emergency rooms, the most expensive type of treatment. I have an office Copay of $15 and an Emergency Room Copay of $75. That is very reasonable, I know.
Observations:

3) Probably a correct observation that Obamacare is a much better deal for the insurance companies than Medicare or Medicaid. That was the plan all along to get insurers on-board to help pass Obamacare.

Post-appointment report:
WC, I was super disappointed because although my (previous) doctor here, in Encinitas, takes Healthnet HMO, her office manager told me there was a mistake. They don't take Healthnet HMO through Covered California. So I sat there like a dummy, for over an hour, because Bob had dropped me off half an hour early, to fill out forms, as it was to be my initial appointment (he had errands to do, so we thought it would save car trips). I feel like filling out a grievance with our State Insurance Commissioner, because I don't think it's right that a doctor's office or clinic, which accepts a particular insurance can cherry pick it and say, but not if it's affordable healthcare, fully subsidized through an HMO by that same insurance provider. But another friend had told me that it's hard to find doctors that accept new patients on Medicare, as well. My point is, there are a lot of politicians, as well as health care providers, who don't WANT the affordable healthcare act to work.

I came back home and called up Healthnet, had to wait only a few minutes this time, on hold less than five minutes, to speak to a rep. I have now changed my Primary Care provider to a doctor in Oceanside. I tried to call her office, to make another initial appointment, which the Healthnet rep had said I could, but when I called the doctor, her intake lady explained I'm not in the system yet. So once again, I called back Healthnet, and was then told it could take five to seven days for my change in primary care provider (they call it PCP, ha ha) to show up in the system, for the doctor's office to verify. In other words, I'm going to wait until a week from today, and call for another appointment.

I checked out the doctor, and she got good reviews online. Originally, I hadn't wanted to be associated with Tri-City Medical Center, but someone told me they are good, too. The issues they have had, in the news, have been political or administrative, not anything to do with the quality of the physicians. I am willing to wait, as I don't have an emergency, but the system I am disappointed in is the system of capitalism that puts the monetary bottom line of greatest profit as the overriding priority.
Observations:

4) Not surprising about the appointment SNAFU -- that's not just a government health care thing but this kind of thing happened often with our byzantine pre-Obamacare health insurance system.

5) Interesting that Obamacare patients are relegated to a lesser list of providers even within the same insurance company. Tri-City Medical Center is not only 15 miles away with ancient facilities, it's also the kind of place that sees a lot of gunshot wounds and stabbings, if you know what I mean. Was Obamacare intended to be second-class health care? It certainly wasn't advertised that way.

Sue is certainly better off under Obamacare than without insurance, and possible better off than she'll be on Medicare.  But if the best thing that can be said about Obamacare is that some people are better off after being given heavy subsidies, that's damningly faint praise indeed.

4 comments:

K T Cat said...

The good news is that Sue won't have long to wait for things to change. Everyone involved is running a loss, subsidized by printed money from the Fed. When the inflation and/or budget cuts start rolling in, Sue and everyone else will see some serious changes.

Yay?

Tom said...

All the whining about insurance companies making profits, but what evidence is there that they're making any money?

K T Cat said...

Are they making any money? Not much. Aetna's profit margin is an anemic 4.4%. By comparison, Google's profit margin is above 21%.

WCV said...

Yeah but they are guaranteed a huge taxpayer bailout if they lose money.

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