Friday, January 29, 2016

A Doctor Shops For Obamacare

It was all a lie. In one of the biggest untruths ever told to the American public, President Obama promised that passage of the Affordable Care Act would not affect their relationships with their physicians or insurance companies. Whether that was just a cynical way of fooling the public into supporting his plan or he is completely clueless about medical economics, we now know that many Americans will have to change their healthcare because of the ACA. I should know. I just became another victim of the lie.

I had a wonderful health insurance plan. Since I am a private contractor, with my own medical corporation for my anesthesia practice, I have to buy my insurance in the individual market. I've had the same plan since I finished residency over a decade ago. It had a low deductible, a wide range of doctors to choose from, and it was cheap. Then it all started to change.

For the last several years my insurance premiums were increasing at 15-20% per year. As a physician I thought I could afford the increases since I made a decent income and I could write it off as a business expense. I had been reluctant to change my insurance because it is a grandfathered plan, one that was in place before the passage of the ACA. The insurance company kept warning me that if I changed plans, I could never, ever get the same plan back.  But after another 20% increase in my latest notification, I was looking at monthly premiums that could pay for a mortgage on a decent sized house in the Midwest. Our insurance agent explained to us that we were victims of the insurance death spiral. Because the plan was so generous, only the sickest people kept the plan. Consequently the insurance company had to raise their premiums to make the plan solvent. As the premiums kept rising, more and more people dropped out, leaving only the very sickest people still in it who needed the plan's benefits.

My wife thought we were crazy paying this much for insurance, especially with three young children to raise and me driving a twelve year old Honda. Reluctantly, we decided we needed a new health insurance plan. Thank you President Obama. We called the insurance company, cancelled our long treasured plan, and had them stop automatic withdrawal from our bank account. Though it was a difficult decision, I felt a huge burden lifted by not having to pay those extraordinarily outrageous premiums anymore.

Where does one go to buy health insurance now on the individual marketplace? In California, one goes to Covered California, the health insurance exchange set up by the state to sell Obamacare plans. The site has improved significantly since it opened two years ago. It's almost bug free now and easy to navigate. It still classifies plans based on different metals: bronze, silver, gold, and platinum. They all essentially cover the same benefits. The differences are the amount of monthly premiums and the amount of the deductible. We chose a silver plan which is a good compromise between the premiums and the level of deductibles one is responsible for paying. Even though my income does not allow me to receive any subsidies from the government to pay for insurance, the new plan instantly lowered my monthly premiums by over fifty percent. Yeah.

Now the bad. The plan has a narrow network of physicians. Before we selected it, we had to call all our doctors to see if they used it. This is where things got messy. Our pediatrician used it but our dentist did not. Then the pediatrician's office manager says he may not keep using the same insurance company after March. But we needed to know now so that we can choose which plan to purchase. This kind of conversation never took place with our old insurance. There goes the promise of keeping our old doctors with passage of the ACA.

The Obamacare plan also has an enormous deductible. It carries a family deductible of over $18,000 per year. It essentially has become a catastrophic insurance plan, with us being responsible for everything unless a major health disaster happens to us. We could have chosen a gold or platinum plan with lower deductibles, but then the monthly premiums start approaching my old plan's payments while providing worse benefits. Thankfully on my income we think we can handle a health calamity even if I have to sell some assets to do it. But how does this help people who don't make six figure incomes?

So as we start out a new year, we have shed one of the major financial burdens that confronted us every single month. Yet I don't feel any more secure about my health and fiscal situation. I feel like we've been railroaded into buying inferior insurance and we could not do anything about it.

1 comment: