The current administration seems to think that the only issue with the health exchange is the website itself. This could not be further from the truth. The goal of the exchange, of the Affordable Care Act, was to bring affordable care not to a select few, but to everyone.
The premiums for these new plans are designed to look like they are headed in the right direction. Let’s look at the family plans. The plan at one particular small business went from $1,196.28 in 2013 to $1,018.18 in 2014 -- great, right? Not so fast. The 2013 plan only had a $5,000 deductible with a $7,000 out of pocket maximum. Once you hit your deductible, you didn’t have to worry about paying a percentage of your care. The 2014 plan has a $4,000 deductible with a $12,500 out of pocket. This is significant because with the 2014 plan, you do have to pay a percentage of your care -- 50 percent of any hospital stay, emergency care, etc., until you reach the out of pocket maximum. The true cost of these plans is $1,779.61 for 2013 and $2,059.85 for 2014. Congratulations, your premium just went up $280 a month.
And it gets better. Take, for example, having a baby. Estimated costs of a normal, no-complications delivery are between $8-9,000 with about a $2,000 physician fee. So with the 2013 plan, you are looking at a cost of $5,000 for delivery, assuming you have not met your deductible. If you have, it is a covered service and no additional cost to you. With the 2014 plan, your cost has just become $4,000 for your deductible followed by 50 percent of the rest of the cost. Final total with the 2014 plan: $7,500. Even if you have met your deductible, you are still looking at a bill of $5,500 (50 percent of the billed amount). For a cesarean section (about $16,000) the costs would have been $5,000 in 2013 instead of $10,000 with the 2014 plan. Please note that your hospital bill doesn’t include what you’ve already paid for in premiums.
And it gets better. Instead of a $100 copay with the 2013 plan, you are now looking at 50 percent of an emergency room visit charge. Even health care professionals are hesitant to seek care when they know the average ER visit is over $1,000. Ambulance transportation, surgeries, imaging studies and labs can quickly escalate that cost even more. So what do you do? You postpone care to avoid that pesky $12,500 out of pocket. You don’t go get stitches for your wound. You don’t go get an X-ray of your twisted ankle. You don’t go get worked up for a cardiac event, and you hope it fixes itself. Then, a week or a few months later, your cut has been infected with MRSA and still hasn’t healed and now requires IV antibiotics through a PICC line and an inpatient stay. Your twisted ankle was actually broken, and what may have been a cast before now requires surgery. Your cardiac event was a blocked artery and you are now being airlifted to a specialist who can do emergency surgery on an inpatient basis, instead of what would have been routine angioplasty on an outpatient basis. Your recovery time just skyrocketed. You are now going to miss 3-6 months of work, instead of 3-6 weeks. The cost of health care for everyone just went up exponentially.
I recommend running the numbers again -- let’s get health care that is actually affordable and obtainable. Let’s push for outpatient and preventative care to help decrease overall costs. Let’s make health plans that actually work for us. If you want to see more working young people sign up for health insurance, why not give them something that is worth the premiums they are paying?
Ashley Illinski is a Radiologic Technologist and CPR Instructor who lives in Arlington.