Middle Americans Again Pays the Higher Price for the Affordable Health Care

It seems that when ever a law is passed that forces many to finance the cost of a program for all, that the big corporations can always fond a way to avoid the costs and the responsibilities that the rest of have to bear. Even better is that there develops another industry who benefits from finding ways around the laws.

Take for example the Manahatan-based startup called BeneStream who offer a subscription service to employers that analyzes the pay of each employee and help them enroll eligible candidates in the Medicaid program. This way the business can capitalize on language in the employer mandate, which will go into effect on January 1 that allows a family of four making less than $32,900 to enroll in Medicaid in lieu of private coverage. The so-called “employer mandate” requires companies with more than 50 full-time employees to provide health insurance will take effect, and commensurate surge of insurance business is expected to follow. BeneStream charges subscribers a one-time $40 registration fee and $200 annual maintenance fee per employee and estimates that between 20% and 40% of employees at hospitality and home healthcare companies are eligible for Medicaid.

This doesn’t sound too bad until you realize the future problems. First, more Medicaid patients in the healthcare system means that those patients covered by Medicaid will have to find physicians and health care systems that will provide services for the lowest paying insurance coverage. Many physicians now limit or deny coverage for the Medicaid covered patients. I myself as a health care practioner will not allow these patients into my practice due to the fact that Medicaid pays our practice basically 10 cents for every dollar billed when compared to what other third party insurance companies will pay. Most of the time, in a surgical practice, this will not even cover the overhead of the practice.

Also, companies can’t force employees to enroll in the Medicaid program, but they can encourage them strongly to do so by offering a plan that complies with the ACA’s minimum requirements, but provides less coverage than the Medicaid option, while simultaneously providing an easy pathway to enrollment in the government program. The BeneStream plan cost employers considerably less per employee than providing a private insurance plan that ensures that they avoid the expensive fines and penalties associated with flouting the employer mandate.

This then forces the middle class working stiff to come up with additional funding for the ACA through higher insurance premiums and higher deductibles to maintain a sustainable health care system.

“It’s a false promise of affordability,” says Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms. “If you ever have to use the plan, you won’t be able to afford it.”

Remember that coverage through the Affordable Care Act is divided into five types of plans that require different levels of cost-sharing. Platinum plans pay 90 percent of medical expenses, on average; gold plans, 80 percent; silver plans, 70 percent; and bronze plans, 60 percent. Tax credits to help pay premiums are available for people with incomes up to 400 percent of the federal poverty level ($46,680 for an individual in the 2015 plans). In addition, a catastrophic plan is available, mainly to people younger than 30; it covers only limited services before the deductible is met and isn’t eligible for subsidies.

People are worried about being able to pay for health insurance. So the insurance industry and a group of Democratic senators have proposed offering cheaper, skimpier “copper plans” on the health law’s marketplaces that could draw in people who were unhappy with the cost of available plans.

But consumer advocates and others who study the insurance market suggest that there may not be a big demand for these plans and that they could expose people to unacceptably high out-of-pocket costs if they got sick, which includes the very higher, and in the future even higher deductibles. But the corporations are finding the ways around their responsibilities, just like their approach to paying taxes by having a European office or other foreign partner to avoid taxes, which the rest of we tax payers have to make up the deficit.

Professor Jason Reed made an interesting comment when he was discussing the March on Wall Street movement in order to understand economics and parasitism. A part of his lecture can be applied to our discussion: A successful parasite is one that is not recognized by its host, one that can make its host work for it without appearing as a burden. Such is the Ruling class and Big Business in a Capitalist society.

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