Unable to Meet the Deductible or the Doctor

[eridani]

http://www.healthcare-now.org/unable-to-meet-the-deductible-or-the-doctor

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.


“To spend thousands of dollars just making sure it hasn’t grown?” said Ms. Wanderlich, 61. “I don’t have that money.”

About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.

Insurers must cover certain preventive services, like immunizations, cholesterol checks and screening for breast and colon cancer, at no cost to the consumer if the provider is in their network. But for other services and items, like prescription drugs, marketplace customers often have to meet their deductible before insurance starts to help.

While high-deductible plans cover most of the costs of severe illnesses and lengthy hospital stays, protecting against catastrophic debt, those plans may compel people to forgo routine care that could prevent bigger, longer-term health issues, according to experts and research.

[dembotoz]

1. in wisconsin without medicaid expansion-policy options where not really good

when i looked last winter.

[FlaGranny]

2. Single payer!

When will we ever get medical care for all our citizens?

[handmade34]

4. yup

as much as I appreciate ObamaCare and the attempt to make medical care better... there are still way too many holes... went to get a flu shot yesterday... no one will take my insurance out of state... does me no good since I work on the road most of the time

[Nuclear Unicorn]

6. I'm sure the next senate will get right on that. nt

[davidn3600]

8. We had 60 votes in the Senate and still couldnt get it done

The industry has too many politicians in both parties paid off.

[Lydia Leftcoast]

12. Yup, and I do blame Obama for kowtowing to the Blue Dogs

and making the much more numerous Progressive Caucus submit rather than the other way around.

[Doctor_J]

28. A huge reason the party got trounced in 2010

millions of new 2008 voters realized they'd been lied to.

[annabanana]

35. I blame Joe Lieberman

really

[tkmorris]

34. That's why you push as hard as you can for it

Of course they won't do it. But you keep making the case, loudly and publicly, again and again. Bring it up every chance you get, and when stories like this appear in the media you stand up tall and proud and make the case why it's necessary. Find ways to bring it to a floor vote, knowing it will be defeated, just to get them on record as against it. Hang them with those votes and get new Senators in their place. MAKE IT AN ISSUE THAT WON'T GO AWAY, and slowly, inch by inch, swing the public to understand why we need to have it.

Then, one day in the not too distant future, you win. But none of that happens if you don't try.

[Lydia Leftcoast]

44. Yes, that's how we got women's suffrage

It took repeated efforts, and several states allowing it, before women's right to vote was put into the Constitution.

[Doctor_J]

23. As it stands now, never. The ACA has made it nearly impossible

If the president had gotten something in the "negotiations ", like lowering the Medicare age to 60, or a public option, we might have been on the road to SP. But by giving in to Insurance and Pharma entirely, he had made Medicare For All just about impossible.

[MadrasT]

3. Tragic.

Saw this coming a million miles away.

[Nuclear Unicorn]

7. Were you one of the Cassandras warning against this back during the law's debate? If so

maybe we can hang out together and show each other our scars from where we were raked over the coals.

When the catastrophic-coverage only plans were being cancelled everyone kept clucking that those were bad plans that had no use. First, I noted that telling people they were stupid and didn't know what was best for them was a lousy electoral strategy. Now we see that the new plans are no better than catastrophic coverage except now the policy holder has less money to spend elsewhere because the policy is so expensive do to all the additional coverage that has been mandated -- which they can't use because the deductible is now too high.

It was glaringly obvious to anyone was actually paying attention.

[Lydia Leftcoast]

13. I was one of the ones who argued that Obama was caving again

and that the proposed law was too complex and non-transparent.

I pointed out the following facts:

1) It was nearly impossible to find an executive summary of the proposal--I had to dig through several layers of the Kaiser Foundation's website to find one.

2) The lack of transparency created the impression that Obama was working for single payer, which
a) Gave false hope to liberals, since
b) The right wing was dredging up horror stories from British and Canadian tabloids, knowing that the average American doesn't realize that the two systems are entirely different,
c) So it was not unreasonable for liberals to believe that Obama was working on single payer, since they had no information other than what the right-wing was telling them, even though they thought single payer was a good thing instead of a bad thing.

3) While single payer was supposedly "impossible," Obama in 2009 had some of the most enthusiastic and energetic volunteers I had seen since 1972, and they were still "warm" from the election campaign. If Obama had really wanted to institute single payer, he would have mobilized his volunteers to go out into their communities and spread the word.
He would also have borrowed a tactic that Reagan frequently used and gone on TV to explain his plan in no more than 5 bullet points and then urged the audience to contact their Congress critters if they agreed.

4) When the public option was scrapped (It would have been easy, both in practical terms and in explainability, to drop the age for eligibility for Medicare by five years every year. This would have had the added benefit of shoring up Medicare's finances, since younger people are usually healthier), I knew that we were going to get Romneycare.

[suffragette]

17. Lydia, you've always made some of the most thoughtful and perceptive posts on this topic

Just want to say I appreciate that and agree with you completely.

[Doctor_J]

24. The junk plans are making a comeback anyway

Big Insurance is lobbying for "Copper" plans, where they will take the mandatory premiums and provide even less.

There is no way a republican president could have pulled off such a travesty.

[KG]

5. oh c'mon. Affordable Crap Act is the greatest thing ever in the history of mankind. because obama!

[tridim]

10. McConnell LOVES you. nt

[FlaGranny]

11. No one ever thought that.

Not that I know of. Only a step in the right direction. Obama got what he could, but he foolishly gave ground before even starting negotiations, thinking he would get a tiny bit of cooperation. Took him a while to catch on that there would be no cooperation from troglodytes. I attribute his foolishness in this regard to his spirit of cooperation and good will. Unfortunately there is no good will among the troglodytes.

[Lydia Leftcoast]

14. He'd been in the Senate and still thought the Republicans had good will?

He met in closed-door session with the insurance companies to see what they would be willing to accept? (Why was it OK for Obama to do this--while dissing the single payer advocates--when it was not OK for Cheney to meet in closed-door session with the oil companies? Should we let serial killers have closed-door sessions with elected officials to see what laws against murder they will accept?)

[Corruption Inc]

22. Oh, so it's all the "troglodytes" fault and nobody ever gloated over having health insurance?

I hear cigarette smoking isn't bad for ya either, LOL.

[Doctor_J]

25. It's a step in the wrong direction

quite obviously. Right direction: no one deals with insurance companies. ACA: Everyone deals with insurance companies. Can you comprehend the difference?

[FlaGranny]

43. Not all bad.

Many people who could not get insurance because of preexisting conditions now have it, including many young people on their parents' policies. I'm still disappointed in Obama about single payer, but at least more people have access to some care. No, it's not enough and yes, it is a boon to the insurance companies. Do you really think this country with all its conservative idiots is going to allow more? If the Republicans take the senate we may lose what we already have (including more than insurance).

[UglyGreed]

9. K&R N/T

[LWolf]

15. I've been saying this all along.

Insurance that we can't afford to use isn't a step forward.

[liberal_at_heart]

16. +1

[RiverLover]

18. My sister is in the same boat.

She has her own small business and a rather expensive pre-existing condition. Her insurer dropped her because they were not going to be doing business in her state after this year. (My belief is they're dropping every policy in state and then start again with healthy people after a year...)

Anyways, the best quote she could get with Obamacare is $500/month with a $6K deductible. She feels like she'd being paying a high price for no insurance. She's going to go without.

And she HATES Obamacare.

[madville]

19. I've paid $5,000 out of pocket this year

But total bills have been about $25,000. I have had to prepay the 20% up front though before the two surgeries before they would even set an appointment. So someone broke would be out of luck, I've run it up on my VISA since I didn't have the cash at the time.

And just got a $923 bill yesterday from a primary care doctor I had blood work done at in February, guess they decided all of a sudden I didn't pay enough the first go round so gotta fight with them this week.

[Doctor_J]

27. $923 for a blood test, fighting with insurance companies. That's the ACA

The insurance companies have always been the worst part of the system. Heritage Care make everyone in America a captive customer. Yippee!

[woo me with science]

20. How bad is it?

Medical Debt: A Curable Affliction Health Reform Won’t Fix
http://www.pnhp.org/news/2013/june/medical-debt-a-curable-affliction-health-reform-won%E2%80%99t-fix

The high frequency of medical bankruptcy was often cited by advocates of health reform during the debate over the ACA. Yet the debate largely ignored the fact that most medical debtors actually have coverage. In order to protect Americans from bankruptcy, coverage must be truly comprehensive, that is, it must cover virtually 100 percent of all needed medical care. Unfortunately, the insurance policies mandated under ACA are required to cover only 60 percent of expected health-care costs.

http://www.nerdwallet.com/blog/health/2014/03/26/medical-bankruptcy/

56 MILLION Americans under age 65 will have trouble paying medical bills.

Over 35 MILLION American adults (ages 19-64) will be contacted by collections agencies for unpaid medical bills.

Nearly 17 MILLION American adults (ages 19-64) will receive a lower credit rating on account of their high medical bills.

Over 15 MILLION American adults (ages 19-64) will use up all their savings to pay medical bills.

Over 11 MILLION American adults (ages 19-64) will take on credit card debt to pay off their hospital bills.

Nearly 10 MILLION American adults (ages 19-64) will be unable to pay for basic necessities like rent, food, and heat due to their medical bills.

Over 16 MILLION children live in households struggling with medical bills.

Despite having year-round insurance coverage, 10 MILLION insured Americans ages 19-64 will face bills they are unable to pay.

1.7 MILLION Americans live in households that will declare bankruptcy due to their inability to pay their medical bills.

Three states will account for over one-quarter of those living in medical-related bankruptcy: California (248,002), Illinois (113,524), and Florida (99,780).

To save costs, over 25 MILLION adults (ages 19-64) will not take their prescription drugs as indicated, including skipping doses, taking less medicine than prescribed or delaying a refill.

[Jim Beard]

21. It isn't perfect I admit

but at least it is a start. My premiums for being a self employed person under the high risk plan in Texas were $958 a month before I was able to get on Medicare.

It should be better but a step at a time. Even with the Bush Medicare part D (prescription Drug) I am in the doughnut hole and am ordering Advair from Canada.

eridani, did you used to post to the old Time magazine Pathfinder boards in the old days. I was jimbe5 or Ronald Reagan Republican which really frosted their buts since I always posted as a liberal.

[Doctor_J]

26. It's not a start

And I am not surprised that a Reagan Republican likes it.

[Jim Beard]

30. Come guy, please read

My name was Ronald republican republican so I would frost the right wingers ass by posting for liberal causes. Geeez, get a life and qiut jumping to conclusions unless you are the republican. Hell, I want Medicare better but does that make me a republican. Get a life buddy.

[SheilaT]

29. The question that always needs to be asked -- and answered -- in cases like this,

is what sort of coverage did that person have before? Was it really better than what they have now? And to those who think the old catastrophic coverage only policies were a better deal, catastrophic only would not help Ms. Wanderlich, because it wouldn't cover the monitoring.

Or to the person whose sister was dropped because of a pre-existing condition, would she really have been able to get cheaper coverage before the ACA? Keep in mind she was dropped, so she probably couldn't have gotten any coverage at all.

It is a shame that so many companies are happily going to the $6,000 out of pocket, but that doesn't mean that the first $6,000 spent comes out of pocket. No, that's the amount you can wind up paying before everything is covered. Meanwhile, regular check-ups are free, along with some other mandated services, which I can't name right away.

I know it's very important to read the fine print on anything.

[quadrature]

36. the whole purpose of ACA was to allow ICs to dump sick people...

remember, the ACA requires certain types of coverage
that most policies would not have had

[SheilaT]

39. No. The point was to allow people to get coverage who'd never been able to get it before.

Hence the elimination of pre-existing conditions. People who had those -- and they could be defined rather loosely by the insurance companies -- often couldn't get coverage at any price. So someone who was dumped in the past because of that, has benefited from the ACA because they can now get coverage. Plus the premiums were often going up at rates far greater than that of inflation, and there was no check on how much the companies could use for salaries and bonuses.

The ACA is a long way from perfect, but it's a huge improvement.

[RiverLover]

40. In my sister's case,

she feels she lost her coverage because of Obamacare. In her mind, ICs are dropping entire states' coverage because it allows them to cut high costs due to ACA and skirt the pre-existing condition rule. Then they can come back in the state and get healthy ppl plus those with pre-existing conditions who will pay a whole lot more.

In her case, the cost is too high. She'd rather save $500/mo in a special savings acct of her own, set aside for possible health costs than pay $500/mo to a company in order to not have insurance. (her words) She'll save up $6,000/year. If her costs go higher than that, which is possible but not a certainty, there's always credit card debt.

I always believed Bill Maher's take on how great ACA was, until her situation came up. Like others have said, it seems like this was more a gift to ICs than a benefit to their customers. Unless of course you have a pre-existing condition and are wealthy and just want to cover catastrophic.

[SheilaT]

41. If she lost her coverage due to a pre-existing condition,

that would have happened BEFORE the ACA came into effect. So she was screwed over by the insurance companies in the first place To blame the ACA is to misunderstand it. Exactly what kind of coverage did she have before? What were her deductibles? What was covered? How much did it cost her?

I do not expect you to answer this, but all too often people think they had a great insurance when they really didn't.

Don't get me wrong. I understand we still have a long way to go with this. I recently went on Medicare and I'm very pleasantly surprised at how good it is. I'm actually seeing a doctor regularly for the first time ever, and so far it's costing me nothing beyond what I have to pay for the Part B and Part D, which is then given over to my Advantage plan. THIS is what we should all have.

I also understand that we can't cover absolutely everything, that some things are going to cost a person more out of pocket. Take, for example cataract surgery, which I had two and a half years ago now, before I was on Medicare but had an excellent plan through my employer. The basics were covered. I chose, and could afford, to pay extra for a better lens implant. Even the basic one would have given me better vision than I'd ever had in my life. I haven't yet had an eye exam from my regular eye doctor since I went on Medicare, but I have a feeling I will pay less out of pocket than I used to.

Oh. Another thought. I know there are some kind of plans available (at least I think they are still available) which involve some sort of Health Savings Plan, where a person puts money into a specific account to cover what the insurance doesn't pay for. Perhaps your sister would do well with one of those, especially as money not used one year can be rolled over, unlike the similar sorts of plans offered through most standard health insurance. I know, as I had one of those, and once they stopped allowing that money to pay for over-the-counter medications, it was essentially useless to me. But where the money can be rolled over, that's quite sweet, especially for someone who might have some nasty large bill at some point.

[RiverLover]

42. They dropped the whole state of Texas

And I'm sure she's not the only policy holder who has a pre-existing condition and is now facing the choice btn no coverage & a policy that sucks and they can't afford anyways.

She pays $275/mo and has a $3000 deductible through Dec. She's been with the same company for many years. I wish I'd asked who it was, I just remember her saying its isn't one of the big ICs.

[Jim Beard]

31. Con on folks

There were many goddamn Democrats that didn't support this much and look at how many good Democrats are running from him now. Cowards. Yes it sucks but it is damn sure better than it used to be. WHY NOT CHANNEL YOUR ANGER TO THOSE REPUBLICAN GOVERNORS THAT TURNED DOWN THE EXPANDED MEDICAID.

[KingCharlemagne]

33. ACA was never 'healthcare reform'; ACA was at most 'health insurance

reform'.

"Healthcare reform" would have meant nationalizing some or all of the healthcare system. Instead, we still have a capitalist, for-profit healthcare system, but with a few more regulations, like no denial of coverage for pre-existing conditions.

I don't blame President Obama for this per se, except insofar as he is a capitalist. I blame capitalism itself.

Full disclosure: our deductible is that $10,000 + $2,000 for something (don't remember what). Means a real financial emergency will make us formally bankrupt and will probably mean we lose our condo. Just had to switch providers when the original one started playing footsie with us about covering my wife's annual preventative care visit and wanting the co-pay for it, even though it's supposed to be free. Feels just like old times.

[progressoid]

37. Yup. That's me.

[uppityperson]

38. I was on that position last yr and it is awful. This yr have very good coverage though I have had

to travel an extra hour to find an ENT who takes my insurance.

But having just had a "do" with the medical system, am very glad. My bill will be a couple thousand of which I will have to pay little. My problem was either something serious or something minor. ct scan ruled out the serious thing, ended up being treatable by antibiotics and pain meds and I am so glad to not have to worry about making the choice between debt or continuing to worry.

More changes need to be implimented for sure for those who continue to be stuck with that choice.

[Mr Dixon]

45. Agreed

The Deductible are murder, saw my wife’s plan last week with all the bells a whistles deductibles were way to high for family or Single, Glad she is covered under my plan.