I've listened to snippets of the SCOTUS hearing and I just can't keep quiet. Perhaps people really don’t understand. My remarks are factual, not political. This is the arena where I have lived and worked for more than 30 years. First, The ACA does not guarantee healthcare for preexisting conditions. In fact, except for wellness, the ACA does not guarantee healthcare at all. What the ACA guarantees is the opportunity for anyone who can afford to purchase health insurance, to purchase a plan that does not exclude pre-existing conditions. For the lowest income earners who qualify for subsidies and cost sharing, the ACA makes health insurance and healthcare affordable. Access to care can be more difficult and the choice of providers is limited, but this group can find affordable care. For those who qualify for subsidies only, insurance MAY be affordable depending on how large a subsidy is received, but deductibles and out-of-pocket maximums run around $7000 a year, or $14,000 for enrolled families. ACA Employer Sponsored Plans are usually more affordable, not because they are less expensive but because employers subsidize the cost of insurance. Unfortunately, many employers subsidize only the cost for employees (not dependents), so spouses and children are frequently left uninsured. Here again, deductibles and out-of-pocket maximums often run in the $7000 range. Adding insult to injury, to help fund the cost of health insurance which has increased dramatically since the onset of the ACA, many employers have reduced or eliminated other benefits that were previously provided. For people who are insured, the ACA has created a disconnect between consumers and suppliers of healthcare. Rather than being left with thousands of dollars in uncollectable debt, providers frequently require patients to pay remaining deductibles and anticipated out-of-pocket costs BEFORE booking facilities or scheduling treatments and procedures. What a mess this GAP creates when multiple providers are involved, and all want to assure they will be compensated for their services. I have witnessed three such situations in the past three weeks. Providers required between $2700 and $7000 just days before a hand surgery, beginning a therapy series, and a cancer surgery. In two of the three cases, services were delayed. The person owing $2700 was granted care but not without hours of intervention. In my experience, most of the people who applaud the ACA fall into one of three camps. They are insured by large employers who heavily subsidize insurance premiums (this includes politicians); they qualify for individual subsidies and cost sharing so they personally have low deductibles, copays and out-of-pocket maximums; or they qualify for the Medicaid expansion which was also ushered in by the ACA. These groups laud the ACA so loudly that they drown out the cries of young people and families who can't afford either the high-priced premiums or the cost of healthcare.
Between monthly premiums and the actual cost of healthcare, a single person in their 20s can easily incur $10,000 in health-related expenses before receiving needed care. A family might run upwards of $30,000. Is it any wonder that many people feel forced to simply take their chances?
The ACA solved a problem for a few, while creating an impossible situation for many. Personally, I see more uninsured spouses and children now than ever in more than 30 years. Even the number of employees opting to go uninsured is staggering. People cannot afford the high cost of insurance and then the even higher costs of healthcare, both exacerbated by the ACA. The fact is, the ACA does NOT protect most people with pre-existing conditions. Remove politics and the bigger picture becomes clear: the healthcare system is more broken today than it was before the ACA. Holding on to the ACA and purporting that it protects people with pre-existing conditions is misguided at best and prevents finding real solutions to the healthcare crisis in America.
(Preview of a coming attraction, "Politics Aside, Medicare for All will not fix the American Healthcare System")
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