Health and Human Services Secretary Sylvia Burwell recently declared that the latest ObamaCare sign-up tally was proof that the exchanges offer “a product that consumers need, want and like.

 

Yet the one family that she highlighted to demonstrate that “the Affordable Care Act is working” does more to cast doubt on her claims than to back them up.

Is it really proof that a family wants and likes your product if you threaten to impose a $650 tax on them for not buying it when the product costs only $492

And how badly does any family really need coverage that won’t begin to pay for medical treatments until after their finances are blown up

A million or more ObamaCare customers may find themselves in roughly the same straits this year. An individual earning a bit more than $20,000 a year will be able to buy a bronze plan for less than the minimum $325 individual mandate that the government will impose at tax time next year, the Kaiser Family Foundation health insurance marketplace calculator shows.

The same appears to apply for a family of four earning a bit more than $40,000.

 

 

Don’t Get Sick

Of course, even though a family would have to throw away money if it doesn’t buy your product, that doesn’t mean that, the family isn’t a happy customer.

A closer look at the family that Burwell touted as a success story chosen by the Gonzalezes, whose income puts them at about 160% of the poverty level, could have them pay as much as 33% of income before it starts covering non-preventative medical bills. That’s a deductible for the Gonzalezes’ family of about $13,000. Can you believe that? Is that fair to a hard working family? How do they manage their health care costs? When does the insurance plans start to assist them in caring for the family?

Yet in the same op-ed, Burwell touts a Commonwealth Fund survey revealing a drop in the number of Americans putting off necessary care or facing financial distress because of medical bills.

That’s undoubtedly true, given that more than 10 million have joined Medicaid since the fall of 2013. The subsidized ObamaCare exchanges also have contributed to making health care bills more manageable — at least for low-income households able to afford silver-level coverage. Silver plans have extra cost-sharing subsidies to hold down medical expenses on top of premiums.

The Gonzalezes could have gotten a silver plan for about $142 a month, or $1,704 a year — an extra $101 per month vs. bronze coverage. It would have shrunk their deductible to $2,900 this year — $9,700 less than the plan they chose — while limiting their maximum expense (excluding premiums) to $3,800.

Signing Up To Avoid Fines

In January, the Congressional Budget Office cut its projection of spending on cost-sharing subsidies through 2024 by $39 billion because it expects that 3 million low-income ObamaCare enrollees will forgo the subsidies.

“Some people purchasing coverage through exchanges solely to comply with the individual mandate will be focused on minimizing their premium payments and thus will continue to choose bronze plans,” the CBO said.

This all goes to a point that the Oregon experience posed, even though you give every one insurance for health care doesn’t mean that you will change the behavior of the patient nor the heath care delivery people. I believe that Middle America shoulders the weight for the poorly designed program. They are forced to pay increasing premiums and have to put up with the huge deductibles. The high deductibles force patients to procrastinate their annual semiannual and sometimes more frequent needed exams, evaluations, tests, etc. This actually leads to continual more expensive care for the patient.

I spent some quality time with my Dad, who is now in assisted living, at almost 97 years old. It forced me to confront the problem with our population growing older and presenting health care situations that we need to consider. How do we care for the growing senior patient population?

Most nursing homes and even the retirement facilities are running into the same problems that we are also seeing within and outside of the present and future health care program. The conditions at many are deplorable. Patients poorly cared for, waiting to die.

The aging of the “Baby Boomer” population has me scarred. Medicare is in trouble financially. How many years before the funds no longer support the Medicare system- 2020, 2025 or 2035?

Will we need to restrict the type of care that we deliver to our elderly population?

Already in many European countries there are restrictions on the use of total joint replacements, open-heart surgeries and transplant surgery in the older population. What age do we cut off the patient population from needed surgeries and life saving medications?

I’m also wondering whether the health care insurance plans offered by the Affordable Care Act, through higher premiums and even higher deductibles actually do the same. They force us to shift the cost of care to our own wallet or pockets/purses. If you are forced to pay part of the cost of the surgery, it might make us consider avoidance of the costly surgeries and the $10,000 per dose of the costly chemotherapy protocols.

The health care plan that survives will have to deal with these details. How do we deal with these very delicate, emotional issues if we have tort lawyers ready to challenge the health care providers every time they deny expensive treatment if it only increases the survival rate by 6 months or a situation where the co-morbidities, like diabetes, kidney and heart disease, and or age would limit success for the surgery? Let me state now that we do need, if not a group of lawyers, then specialists in ethics to set out the limits and health care treatment protocols.