There are approximately 324
million people residing in the United States.
According to the official Obamacare page 11.4% presently have no
healthcare coverage. They claim that this is the lowest its been in 50 years,
but what do the current plans under Obamacare offer that makes it worth signing
up for insurance. Let’s outweigh the
pros and the cons.
I can only speak for South
Florida because that is where I live.
For those who are not offered
health insurance through their employer, and can’t afford a traditional plan
because of limited income, and costs of living, their only options are
Obamacare or the payment of a penalty once tax season comes around. In South Florida some of the
popular and more affordable plans have been offered through Molina, Preferred, and
Ambetter, just to name some. Of these
currently two are no longer taking any more new enrollees. I’ve come across family, friends, and
strangers who constantly complain about the issues that they are having with
this mandatory insurance. What follows
are some examples of the different issues I’ve been told about:
a. When you sign up, you have to provide an “average”
of how much you “expect” to make the following year because that is how they
figure what you have to pay monthly. So
the average person states the same number they made the previous year which is
fair, and expected. They are then quoted
a monthly amount.
I’ll use the example of one of my family members who
had this happen to him. He was quoted around
$150.00 monthly. Obviously this plan
comes with a high deductible despite it being one of the better plans afforded
by this company. During the year he had
the opportunity to work overtime, which he took advantage of in order to make
more money to support his family. He
also got lucky and was given a raise. It was not a significant amount, but a
raise nonetheless. By the time tax
season rolled around he went to prepare his taxes and was informed that since
he made more money than what he had approximated, he now owed the government
over $1,500.00. He contacted the woman
who sold him the plan to ask about this, and to notify her that he would have much
rather been uninsured, since he is quite healthy, and did not visit any doctors
during the year because the fine would have been $675.00 not the over $3,000.00
that it ended up costing him. Her
response was that she could get him a lower plan with an extremely high
deductible, and that if he fell ill he could call her on his way to the
hospital and she would change it up so he would have better coverage. Yes, she actually offered this. Whether she can make good on it or not, it
was offered.
b. Another individual that I know, who does not
make a lot of money, signed up for Obamacare and based on his earnings he was
paying roughly $45 per month. He had
just undergone open heart surgery and would be needing constant follow up
care. During the following year his plan
went up about $100.00. Obviously he had
to continue to pay because of his health condition. The year after the plan dropped him saying
they weren’t renewing memberships, and the only plan he was able to obtain charges
him over $300 per month, which he can’t afford.
c. Yet another incident involved a married couple who
have Obamacare. Both require monthly
visits due to ongoing medical issues that need monitoring. They signed up with a plan, and a few months later they were informed that they could
no longer be on this plan, no money was returned to them. The wife called the Marketplace and was told
that she could go under a new plan. It
was the beginning of the month and her payments are made on the 15th
of every month. She was told that she could
still go to the doctor that was assigned to her. She asked for an appointment and stood
outside his office for two hours in the sun with her husband and then close to
another two hours inside to see the doctor.
She even took pictures of the ridiculous line and showed them to me. Right
before they were to go in to see the doctor, she was advised that they he would
not see them because she had not paid for the current month. She explained that she pays the 15th
of the month, and she was paid up until then.
The doctor did not care. He
turned her, and her husband away. She
then called the Marketplace again and was told that she could go back and be
seen that they had cleared it with the doctor.
She called the doctor’s office again for an appointment, who again
reaffirmed that until she paid for the current month he could not see them. Needless to say, she had to wait until after
the 15th of the month, when she made her monthly payment to ask for
an appointment before the 30th of the month so that the doctor could
see them. So it appears from what
transpired, that they are only insured from the 15th to the 30th
of the month because from the 1st to the 15th all bets
are off.
d. A close friend of mine who is married and both he
and his wife are insured under the Obamacare plan had an issue when his wife
started having abdominal pains and went to one of the hospitals on the
plan. There she was told that she needed
to make an appointment with her physician to have him check her out and refer
her for a CT scan. She explained that
she was in pain and could not wait for an appointment. They said they were very sorry, but that is
what she had to do if she wanted the plan to cover any part of it, if not, she
could pay for it out of pocket to the tune of $600.00 just for the scan. She ended up buying a round trip ticket to
Colombia that evening, and receiving emergency treatment over there which
required a few days of hospitalization, as well as all the prescription
medication she needed to take care of her problem upon her return. The ticket to Colombia was less than the cost
of the deductible, and the $600 scan.
The medical care in Colombia cost her $1 for her co-payment, because she
is insured and pays a minimal monthly amount to maintain health insurance in
Colombia.
One of my
personal experiences with how the healthcare system is out of control happened a
few years back. I suffer from psoriasis,
as does my mother. I was given a
pharmaceutical sample by a friend of a new medication. I gave some to my mother and it was actually
very good. She asked her doctor for a
prescription since it worked considerably better than what she had been using. She
took the prescription to be filled and was told that the deductible would be
$800.00. Unfortunately, she could not
afford this medication since she is a retired, Medicare recipient. A few month
later I traveled to Spain, and took a sample and the prescription with me. There I walked into a drug store and was able
to purchase the same medication for €55 (Euros), which at the time was about
$70.00 USD. I purchased two, one for my
mother and one for myself.
We hear the
democratic candidates and some of the Republicans singing the praises of
Obamacare, but the sad reality is that from what I have seen, it appears to be
a scam designed to continue to line the pockets of the insurance companies, who
are not accountable in any way. They
also have the benefit of high deductibles so unless you are chronically ill,
and live in a hospital, you will not benefit from having the plan. Other than not getting fined for not being
able to afford it at the end of the year, the benefits are minimal for the
average citizen, for the insurance companies it’s a win/win because with high
deductibles, they don’t have to pay, but they get your money every month.
What we see here
in South Florida is that one company comes in, signs up everyone, takes their
money in advance and a couple of months later they terminate the contract. The “insured” has to then find a replacement
company, who nine times out of ten provides significantly less services at a
higher rate that they can barely afford, with even higher deductibles.
In a recent
debate, Trump indicated that he would open up state lines so all the companies
could compete nationally, and this would drive the prices down. I don’t believe this to be accurate, it would
only expand the scam and make it even more difficult to document. Thus
benefitting even more insurance carriers, and leaving the average American once
again screwed. Bernie also wants everyone to have healthcare
for free, but that means a minimum of an 8% rise in taxes every year, and what
does “free” really mean.
It is
interesting how the government imposes what they feel the public needs in a
manner that only benefits the insurance companies and pharmaceuticals.
Why don’t they
start where the problems originate? Why
don’t they limit the prices that can be charged on medication? Why don’t they have a flat plan that everyone
can afford with zero deductibles and low co-payments? Why don’t they oversee what hospitals charge
on a regular basis for things like slippers? I saw an itemized bill not that long ago for
a patient who had entered the hospital by ambulance and died in the ER. On the hospital
bill there was a $13.00 charge for slippers.
This was absurd since she was horizontal during her entire visit. Unfortunately, they are not held accountable
for the abuses. If they really want to “help”
the average American citizen who can barely afford to live on their menial
salary as it is, much less pay for mandatory health coverage, which offers
minimal or no coverage at all why don’t they do what needs to be done?
Excellent post Laura. Really empathize with everything you said because I've had most of the same experiences on ObamaCare. Cost controls are an absolute necessity and no one talks about these. Keep up the great writing.
ReplyDeleteManny