Web Site Successes

Last night while surfing through Facebook, I noticed that a former classmate had posted about getting enrolled in health insurance.  In reading through the comments to the post, I found that others got enrolled yesterday as well.  I couldn’t figure out why the sudden interest in trying to enroll again.  Then, it dawned on me. 

Today is December 2.  The Obama Administration said that healthcare.gov would be working for the majority of people by yesterday.  Many have doubted this. 

Fixes

The administration claims that it has met this goal.  It claims that the Web site is working 90% of the time as compared to 43% back when enrollment opened on October 1. 

Lags in time can still be a problem, however, and those working on the fixes admit that they would like to get the site’s response time down to half a second. 

They also are unsure if the Web site can now handle 50,000 people at one time.  They won’t know until that many try to access it at once.  

Successes

Back to my former classmate, it took her a little under an hour to enroll.  For her friends, it took about a half hour on average.  These times are back on track with the estimated time pre-enrollment opening. 

By the way, all of these enrollees are healthy young adults in their 20s.  They are helping to even out the pool and can help balance insurance costs.

They all found cheaper plans than what they were previously paying. After subsidies, one person will be paying $40/ month. 

They will have coverage beginning January 1.  If you enroll by December 23 (and make your first payment by December 30), you can too!

My organization’s Certified Application Counselor is planning to have an enrollment session at our office on Wednesday.  I will update you all on the successes and failures of it.  Will we have access to complete the entire enrollment process?  How long will it take on average?  What types of glitches are still present? 

I am hopeful, and I think it can only get better in the next three months before the enrollment period ends.  Let’s attempt to get covered again America!

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.

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).

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.