One of the main goals of the ACA was to get all those Americans without healthcare insurance to be insured. Like automobile insurance, it is now required that a person carries medical coverage. A person is responsible for purchasing their own plans. The way that this happens is that the patient calls or goes on-line the many insurance exchanges and enrolls. If a person chooses not to enroll, they are forced to pay a tax penalty. While that penalty is not so steep this year, it will increase yearly and become quite costly.
But, are patients really purchasing healthcare insurance to avoid these tax penalties? Many are. But, I am still finding many who are not and are choosing to remain uninsured for the simple fact that they cannot afford the premiums. And the plans they are purchasing are not covering them in the way they need.
How is the ACA failing to cover the healthcare costs?
1. Many patients simply cannot afford to pay the premiums. The economy is stressed like never before. Many people have become unemployed and are struggling to rejoin the work force. They are just trying to survive and do not have the money to pay for healthcare insurance. Yet, they do not qualify for Medicaid. They simply have no choice but to remain uninsured and face the tax penalties when they arise.
2. Many of the plans under the insurance exchanges have large deductibles. Patients now are being force to pay their premiums and a huge deductible. When they need to see the physician, they need to pay out-of-pocket until the deductible is met. This is often an extra thousands of dollars. Some of my patients with chronic diseases are forgoing follow-up visits to avoid paying the deductible. I saw one woman cancel her appointment and ask me to see her child only because she couldn’t afford both deductibles. Many patients simply don’t have the money and are choosing to forego care. And sometimes, their chronic disease worsens and the end in the ER.
3. Insurance companies have tightened the formularies. I have not seen anything published about this. But from my experience and from what other doctors are saying, many patients are having their medications suddenly not covered. I have found this to be especially true with asthma inhalers. I have had to spend up to 3 weeks getting a generic asthma medication covered for a patient. For an asthmatic, an inhaler is a life-saving medication. They may not be able to go 3 weeks without the medication.
4. Many patients have had trouble signing up because they were unable to get access to the website or get through by phone. While this has improved, many patients simply gave up for frustration after spending hours trying to get through.
The ACA was meant to cut healthcare costs but is this really being done? There are now many more patients on Medicaid driving up States’ budgets to support these programs. And more money is being paid out by consumers, whether they agree with it or not. Patients don’t feel like they are the beneficiaries here. They feel they are being overly burdened with the premiums and deductibles. So, who is profiting from the ACA? I would have to say the private insurance companies who are running the health care exchanges. Suddenly, they have many more people paying insurance premiums. They are paying out less for medical services because they have largely increased patient deductibles across the board. And they have maintained, or even reduced in some cases, payments to physicians and hospitals. You just have to wonder how much driving force they had behind the ACA.
