Perception vs. Reality: The State of the U.S. Health System

It appears Americans do not see a need for health care reform. Earlier this week Gallup released the results of its annual Health and Healthcare Poll. 

Health care was ranked the second most important issue to focus on in this country. It also ranked highly in the polls of 1993-94 and 2009-10. The pattern? Health care was in the news a lot during these times with the possibility of reform. It is in the news a lot now with the start of actual reform. And the kickoff of the reform has been less than stellar. This poll was conducted November 7-10 this year. By that point, Americans were already exposed to some pretty bad press in relation to the ACA. 

Let’s explore some of the specific findings. 

General Health Care
 Americans rate their own general health care higher than the overall nation’s (this result is on trend with those Gallup has received over the past decade in relation to this question). 

Cost 
Americans are satisfied with the cost of their own health care and view it as more reasonable that the general cost across the country. Although, the majority named cost “the most urgent health problem” in the country. So, I supposed Americans do see room for improvement here. 

Quality 
Quality was rated high in both cases. Seventy-nine percent were personally pleased with their quality, and 54% rated general quality across the country as good or excellent. 


Change is hard. Ignorance is bliss. It’s easier to stay in plans that we think are alright than to find out how sub-par aspects actually are. Compared to other countries, the U.S. doesn’t do too well in relation to these three topics. 

General Health Care
In a couple blog posts ago, I briefly discussed how the U.S. relates to other countries in term of general health care. Our perception doesn't match our reality.  The reality is less than satisfactory. 

 Cost 
“…The world’s richest country spends more of its money on health care while getting less than almost every other nation in return.” – Huffington Post 

“While there is room for improvement in every country, the U.S. stands out for not getting good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first overall.” -- Commonwealth Fund 

Quality 
In one of the comparisons I looked at, the Commonwealth Fund compared the health care systems of seven industrialized countries. They were rated on quality, efficiency, access to care, equity, and life quality and expectancy. The U.S. came in last overall. In terms of quality, we were a little better at a six out of seven. 

When breaking down quality, we came in 4th in regards to  effective care and patient-centered care. The factor that drove down our quality score was the ability to provide safe care. We are the worst at providing safe care. Personally, I consider this to be an essential when talking about quality. We spend more than we need to and can’t even expect to be safe in the end. In fact, procedures such as C-sections and colonoscopies are performed more often than they are actually needed so that more money can be made by the health care industry. Our safety is being risked for profit. 

The ACA offers consumer protections, so that things like this cannot happen.  Our government, media, and the health care industry need to do a better job educating Americans about the ACA so that our perceptions of our health care can meet and improve our reality.

A Song about Benefits of the ACA

The following video offers an entertaining yet informative value to viewers in that it touches upon essential ACA need-to-know ideas.




To expand upon the video, here is an image that summarizes the essential health benefits as well as lists other key perks of the ACA.  I've taken this to community events with me, and people tend to be more accepting of Obamacare once they read this.  

Taxation and health care: A Proven Relationship that Works

“It’s not liberty if it’s mandatory.” “It’s not American if it’s mandatory.”  I’ve read these from my aunt’s Facebook wall many times in reference to the fact that Americans must purchase health insurance in 2014 or pay a tax fine.  First, I’d like to ask her if I can quit paying taxes in general since I don’t find filing and paying taxes to be liberating processes.  But, that’s another issue for another time. 

That got me thinking.  Why did lawmakers intertwine health care with taxation?  I started researching other health systems in the world that are more efficient and better than ours.  It turns out that many require mandatory taxes.

How can you say other countries are better than ours?

First, let me explain what I mean by more efficient/ better.  In all of the studies I found, these factors are based upon things such as health equality, responsiveness and responsiveness equality, lifetime expectancy and lifetime satisfaction (are you able to do a lot at an older age), cost, and health care quality.  Turns out, across the board, we spend the most on health care and have the worst return on investment.  Well, our quality has to be top-notch at the very least, right?  WRONG.  I would’ve liked to have continued living without knowing that fact (including the fact that we rank last out of seven industrialized countries on safe care).  China and Iran are better at this whole health care thing than us, need I say more?

Examples of Countries Requiring Health Care Tax Contributions:

• Andora
• Australia
• Belgium
• France
• Ireland
• Japan
• Malta
• Singapore
• Sweden
• United Kingdom

These Sound Just Like the ACA... and They’re  Successful

I am quoting this information because it is well said in a concise manner.

Belgium: "The Belgian health care system is mandatory and is a mixed public-private system. There are private providers with state-organized reimbursements."

Switzerland: "In Switzerland, health care is guaranteed to all citizens. Citizens must buy health insurance and in return, private insurers must offer coverage to all citizens."

Netherlands: "Holland's universal health coverage is achieved not through the government, which is used primarily as a regulatory body, but through private insurance companies. This system is based on private insurers competing for business."

Singapore: "A government-run universal health care system coexists with a private sector in Singapore. The private sector provides most care while the government controls prices."

Other Criticisms that are Successful Elsewhere

Obamacare has also been criticized for making taxpayers foot the bill so illegal aliens can get covered.  This isn’t true… at least in the U.S.  But, it is in practice elsewhere in countries with more successful systems than ours.

Sweden covers illegals… and it uses taxes to do so (oh the horror… I suppose illegals don’t regularly visit the ER then which is an occurrence here causing high bills for American taxpayers).

Austria is a place I want to visit: Austria even covers health care costs of tourists!!!! 

Enrollment Updates

Local
Today, our Certified Application Counselor was finally able enroll someone online!

The woman was able to look at different plans and compare them.

The woman was paying over $500 a month for insurance.  She selected a plan is $250/ month, and with her tax subsidy, it will end up costing her $70/ month. 

Stay tuned for more details on this story!

*As a side note, though, navigators and certified application counselors (CACs) do not have any special access or magic powers to access the Marketplace. Our CAC has been receiving many phone calls from people looking for her to get them access to the Web site.  The best they can do is sit down with you and hope it works.  If not, they can at least educate you about the law and answer any questions you may have. 

National
We just learned on a conference call that the enrollment period for January 1 coverage has been extended from December 15 now to December 23.

The enrollment period for 2015 will now take place November 15, 2014- January 15, 2015 (It was pushed back a month and extended by a week).

10 Misconceptions about the Affordable Care Act

Important Enrollment Words

Choosing insurance can be confusing, especially if you have never had it before.  A few years ago (a couple years before the ACA said I could stay on my parents’ insurance until I turned 26), I graduated from college, got a job, and then had to enroll in insurance for this job.   Flipping through the enrollment booklet, each page contained an enormous amount of mumbo jumbo.   Thankfully, I had my dad to guide me.  Link to age 26

With the existence of the ACA, more people are able to get insurance.   When comparing health insurance plans, you  may run into the same problems I did.  The following infographic is a great way to get started in understanding very important words. 

If you are looking to be even more fluent in the language of health care insurance, the online Marketplace (believe it or not) is an awesome resource for information and definitions.

 

 

If you can't keep your insurance… where you stand

President Obama upset millions of Americans.  Over the past few years, he said that “If you like your health plan, you can keep it.”  This has turned out not to be true for 5% of Americans.

It appears these plans will be available at least for a little while.  

My Advice: Consider New Options

If this happened to me, I would be mad as hell.  Especially since it’s difficult to access the new plans.  I would be worried about prices and coverage.  But, I would research what I could.  In considering this scenario, I did the research anyway. 

Here’s what I’ve come up: 

-      Any plan that was created before the passage of the ACA in 2010 was “grandfathered’ into the new Marketplace. These remain. 

-      Any plan that was created or changed after 2010 that did not meet the requirements of the ACA would be cancelled at the end of 2013. 

So, yes, the President lied.  But, the plans that people want to keep are expensive and do not carry important consumer protections such as the 10 essential health care benefits.  “Individual policies have long been a problematic part of the insurance market, with higher prices than most group plans, fewer benefits and a tendency to cut people off when they get sick,” says a Washington Post article. 

I am sure with all of this debate that people will have a little longer to choose.  I am personally hopeful that the Marketplace Web site will be working by January 1^st.  I might wait to research coverage and pricing in the Marketplace and compare the information to my current plan.  After all, a plan from the Marketplace not only brings guaranteed better protections, but it also comes with a subsidy to lower the cost. 

Proposed Fixes:

1. Obama: These plans can carry on for one more year.

2. The Senate: A few plans similar to Obama’s have been proposed.  The Landrieu bill would allow for Americans on these plans to stay on them indefinitely.  The Udall bill would allow for these plans to stay around for two years. Then, they would be cancelled.

3. The House of Representatives: Americans on these plans can stay on them, and insurance companies can sell them to others who are shopping around for insurance.  This has already passed in the House and will need approval from the Senate and the President. 

Another twist to all of this: Any decision would also need approval by each state’s insurance commissioner.  

Marketplace Web Site Problems

I've mentioned the Marketplace Web site debacle quite a few times now.  I found a great infographic that goes through different steps of the online enrollment process and the problems that have seemed to accompany each of the steps. So far, only roughly 40,000 have made it through the process. 

Source: Government contractors. Ariana Cha and Lena Sun/The Washington Post. Published on October 24, 2013, 8:03 p.m.

Keep Calm Enrollment Carries On

In a recent Gallup Poll, only a small percentage of uninsured people have visited either the federal or a state-run marketplace.

Percentage who have visited a marketplace:

18% of all uninsured adults polled 

22% of uninsured adults who plan on purchasing coverage

About 1 in four uninsured adults say they plan on paying the fine.  About half say they plan on purchasing coverage. 

How I See It

With all of the news, I get worried about whether enough people will enroll in health coverage this year to really make a difference on the cost.  In taking time to think about everything rationally instead of just reacting on emotion, I am now less worried.

Enrollment has only been open for five weeks.  There are 20 more weeks to enroll.  We can break that down into four 5-week periods.  If 22% visit a marketplace and enroll during each one of these four increments, then basically everyone who said they would enroll will have enrolled by time March 31^st comes around.   

I doubt many people are trying to put up with the botched federal website.  And some of the state-run exchanges have glitches as well.  My guess is more people will visit these sites and begin enrollment in January.  The technological kinks should be worked out by then. 

People also will have had the opportunity to learn about the ACA before visiting and enrolling.  In fact, with the exchanges being so awful, many navigators and certified application counselors have taken to educating communities.  That way, when everything is properly running, people will be well prepared for how enrollment will work and for what is the best sort of option for themselves. 

I also know that our certified application counselor’s phone rings at least once an hour every day.  Today she had 20 voicemail messages left from this weekend.  People are interested.  People want insurance.  People want to be educated on what is best for them.  In fact, when Romneycare first rolled out in Massachusetts, on average, people had 18 interactions with the exchange before finally enrolling.  They were researching their options and taking time to understand how they were affected.  There was a surge in enrollment during the last two months of Romneycare enrollment.  Seven years later, 97% of people in Massachusetts are insured.  

Fear not.  Stay logical.  Get insurance.  Get and stay healthy.  

Why Access to Good Women's Care is Not a Bad Thing

Many of the hot button issues surrounding Obamacare are in relation to women's care.
 Below are a few blurbs about why these issues may not be so bad.  I strongly advise you to check out the links.

 

A Few Words

Birth Control Access is Good for Society
Economist Martha Baily found that access to contraceptives and family planning helps an entire family.   For those who have access, they and their children are show better college completion rates, labor force participation, and higher wages.

Why Charging Men for Maternity Care is Fair
Even though a man cannot physically have a baby, he helps in the creation. And even if a man never has a child, he was once someone's kid.  Read the article from Slate-- it offers surprising reasons why men should be charged for maternity care.  It'll make sense once you finish the article.

A Success Story from Pittsburgh

A Pittsburgh woman was patient in her quest for new health coverage.  Gail Roach was paying $509/ month because of her pre-existing condition (Type 2 diabetes).  After attempting to search prices on the federal Marketplace, Roach called the phone number (1-800-318-2596). The person on the other end of the line found a plan for Roach that will cost $1.11/ month. 

ACA Benefits

ACA Health Care Plan Costs: Explanation and Examples

Example Pricing: Western Pennsylvania

 

Explanation of Graphics 

As you can see, each health insurance provider listed a plan for each of the metal levels which we discussed in the previous blog post.  You may also notice a “Catastrophic” option.  This is available to adults under 30 years old.  It is a very low monthly payment compared to the metal levels, but a higher out-of-pocket expense if the person needs something extra such as an emergency room visit.   

The Catastrophic plan allows for 3 primary care visits/ year with no added cost (compared to unlimited visits with the metal level plans) and must cover the essential health benefits which we covered in the Halloween post. 

Plan Pricing is based on four factors:

Age:

Before the ACA, older people were charged on average 5 times more for health insurance than younger people.  Under the ACA, seniors (age 64 or older) cannot be charged more than 3 times the rate of a younger person’s plan (age 21-63). 

Tobacco Use:

A smoker can be charged 50% more than a non-smoker.  Why would you ever disclose whether you’re a smoker then?  You can potentially lie about this to avoid the higher cost, but if your health claims start looking like you are a smoker, you may have to deal with the ramifications.  Many insurance companies had already begun this extra penalty about 10-15 years ago.

If you don’t want to pay the extra cost and you aren’t brave enough to lie, you do have another option.  As long as you are enrolled in a smoking cessation class (you don’t even have to quit smoking), you should not have to pay a higher cost. 

Family Size:

This depends on factors such as your combined household income (the total of what each member of your family is expected to make in 2014), family members’ ages, and their smoking habits. 

Geographic Area: States are split up into different geographic regions to create smaller, competitive markets so that prices can be reasonable for each region instead of overpriced.  Pennsylvania is divided into 9 different regions.  

Side Note: Plans that were created before March 2010 and remained unchanged in the past few years are “grandfathered” into the ACA.  These plans do not have to charge according to these four factors.  Plans created after this date had to change to fit ACA criteria.  President Obama has been catching heat because of these “grandfathered” plans.

 

Subsidy

Most Americans should receive a tax subsidy with the purchase of their plans.  Any individual making less than $45, 960 and any family making less than $94, 200 is supposed to get some sort of compensation to help them pay for their plans.  You can use the Kaiser Foundation’s Subsidy Calculator to get an estimate on what you might receive. 

A Word of Caution: I am a little worried, though.  Before the Marketplace opened and plan prices were still unknown, I was able to get a subsidy estimate for a 25-year-old non-smoker who made $30,000/ year.  Now, if I enter the same information, the subsidy comes up as $0.  The calculator figures this based upon a silver level plan.   

I am hoping that there is a subsidy for the bronze level plan or that the calculator is inaccurate.  I am not sure how many more “lies” or problems with the ACA the American people will put up with.  

If you are truly curious, I suggest you call 1-800-318-2596.  I imagine someone will be able to tell you what your subsidy would be.

Metal Level Health Care Plans and How to Enroll

Types of Plans

Infographic from ConnectTheDotsUSA.com detailing metal levels for health care plans

Explanation of the Metal Level Plans

Viewing the Plans in Your Area

Pricing differs based on your geographic location and some individual factors.  Even though enrollment has been open for a month, it has been challenging even trying to view plans at this point in time. 

Enrollment opened on October 1, but the online federal Marketplace was not ready to handle the large volume of traffic to the site.  This has made it difficult to even view plans let alone enroll.  Seventeen states have state-run exchanges (Pennsylvania is not one of them).  These have been successful in getting people enrolled. 

How It Works (or lack thereof)

The federal Marketplace is set up in a way that you have to create a user profile before you can view anything.  During the first week of open enrollment, I wasn’t able to create a profile.  The week after that, I created a profile, but then I wasn’t able to confirm it and log in.  Finally, in the past week, I have been able to view plans in my area.  I am still unable to select a plan and enroll.  So, at this point, you may be able to create a username and view plans in your area fairly quickly.  Or, it may take you three weeks to get to the same point as myself. 

The government is saying that the Web site should be fully functional by the middle of December.  By this point, it may be too late to get coverage for January 1^st (you must enroll by December 15^th and pay for your first month’s premium before January 1^st).  Coverage purchased after December 15^th, can begin as soon as February 1^st.   

Other Enrollment Methods/ Access to Plans

There are other ways to learn of available plans in your area.  You can call 1-800-318-2596.  Since the Marketplace debacle, more staff has been added to call centers to help people enroll.  

Paper applications are also available.   Our Certified Application Counselor has helped a few people fill these out during our community outreach events.   

A word of caution: A couple weeks ago she mailed in a few paper applications for people to the address listed on the application.  The letters were returned today with a note saying the address could not be found.  The address was something unreal like 1001 XYZ Drive, Washington D.C.  We Googled it before mailing the applications, and Google found it as an ACA Headquarters location.  We should have followed our hunch; it’s not a real place.  I just checked the application form.  The address has been updated to what sounds like a believable place:

Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd.
London, KY 40750-0001

Recap of Enrollment Methods

Online Marketplace: If it is state run, you should be good to go.  If it is the federal exchange, you may have trouble enrolling.  For the few people I have spoken with who have had success online, they have accessed the site between 2 a.m. and 4 a.m.  You may try this if you would like.

Phone number: 1-800-318-2596

Paper application: It takes about 10 weeks from the time you mail papers in until the time you are officially enrolled.

Community Navigators/Certified Application Counselors: Currently, they are at bit of a standstill.  Unfortunately, they cannot magically access the Marketplace.  They can help you understand what you will need to enroll and answer any questions about how you may be affected by the law.

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UPDATES as of 11-5-2013:

The federal Marketplace is undergoing major repairs from 1 a.m. to 5 a.m. every night and is unavailable between these times.

The Obama Administration is now claiming the Web site should be running more smoothly by the end of this month instead of the middle of December.