I voted for Obama twice. And I hate Obamacare more than Ted Cruz does.
I mean, I wouldn’t force a government shutdown over it. But he’s a Congressman and his wife works for Goldman Sachs, so he has whatever health insurance he wants. I’m a journalist and my wife is an artist, and we can’t afford insurance. So we pay the annual Obamacare penalty and have $30,000 in medical debt.
It’s become a little more personal for us since my wife had emergency gall bladder surgery last summer. Now we get daily mail and calls from collectors. I don’t mind them — they stressed out my wife, at first — because blocking numbers is straightforward and they’re just doing their jobs, after all. I just wish the dawdlers we elected would do theirs, or make way for people that will.
I’m sure the other 33 million Americans without insurance, including 7.7 million young adults, feel similarly. Probably a lot of people with insurance do, too.
Only 535 people can help millions — but they won’t
Part of my problem with Obamacare is how incremental the law is. It was built to come online in phases and gradually nudge people into compliance. The big pieces didn’t kick in until 2014; some won’t until 2020. This leads to a “wait and see what happens” mentality, which really sucks for people who can’t just be perfectly healthy until then.
My wife is one of them. When she immigrated from New Zealand in 2010 to marry me, the idea of avoiding seeking medical care was alien to her. She grew up in a single-income family as one of six kids, and was always able to just walk down the street and see a doctor without any trouble.
Here, after seeing the bill for an immigration-required vaccination and a 15-minute, useless visit to an urgent care center, she learned to live with sometimes severe pain. But after a year of suffering — the pain would come and go, sometimes for weeks, unpredictably — we reached the breaking point. She had pain so bad she woke me at 3 in the morning sobbing, barely able to speak.
Terrified, I drove her to the ER less than a mile away. On the way, between gasps of pain, she kept apologizing. I told her not to worry, and that this wasn’t her fault. The ER quickly decided to admit her for surgery — and so began our exciting tour of the American health care system.
Obamacare is called “Obama’s signature achievement,” but more accurately, it’s the signature failure of Congress. The law’s been broken from the start, watered down nearly to homeopathy. Six years later, it’s no better — mainly for a lack of trying.
Unless you call “razing it to the ground” a fix. Cruz and friends have tried that, more than 60 times. Some of them are still trying, bless their shriveled hearts.
But it seems there are no course corrections on the big issues because there’s always another election around the corner. We got a flurry of action over a few months in 2009, then years of symbolism and posturing from both sides. As a journalist, I regularly get press releases this time of year from the Health Department, touting new enrollment figures and warning of the penalties for not enrolling in Obamacare. Sometimes I want to print them out just to burn them.
Somehow nobody knows what anything costs
After they got my wife some painkillers and our panic eased, we started asking everybody who walked into the room how much this was going to cost.
Nobody could give us even a ballpark answer. They were all very sympathetic as they changed IVs, scanned barcodes, wheeled equipment in and out, or told us what was coming next. One woman eventually brought us a flyer that described a financial assistance program the hospital ran for the uninsured, and warned us not to delay in calling the listed number once we got the bill. We promised.
Eight hours later, my wife had two new scars and no pain to speak of — and a gestating bill of nearly $30,000. Of course, you have no idea how much you owe for weeks. Then the bills start appearing, one by one.
I haven’t been in a hospital overnight since I was too young to remember, so we were both surprised to find out you get a separate bill from pretty much everybody who glances at you, even if it all happens in one or two rooms. And there’s no line-item list pricing everything out, just numbers they seem to pull out of the ether.
Obamacare tried to address a lot of problems, including insurers who discriminated against people with “pre-existing conditions” and establishing some basic minimum coverage. It’s better than what we had before. But it didn’t accomplish much price transparency, and cost — from all angles — is obviously the most important thing, the thing every other problem stems from.
Health insurance ≠ affordable care
I wanted to like Obamacare. It was change I could believe in. I was on Healthcare.gov on Day 1 — Oct. 1, 2013, the same day the federal government shut down because Republicans held hostage the funding for its basic operation over Obamacare. I was eager to spend a couple hours filling out arcane government forms and finding out how I could finally afford to not be anxious about my wife’s health or my own. (She’s had more medical care in the past year than I’ve had in the past 10.)
Of course, the website was an utterly shameful disaster befitting the industry it was built for, so ill-conceived Health Secretary Kathleen Sebelius was forced to resign. Nobody could sign up for weeks. Deadlines were a moving target. The federal government had to spend $54 million on Obamacare “navigators” to help people use the site and sign up — often needing to mail in additional paperwork even after applying online.
When I could finally use the website long enough to see rates, I found even the lousiest “bronze” plans way out of our budget. I thought: Wow, not being able to afford third-rate care is a nice feeling. (I later learned the tiers refer to how much of the total cost the plan supposedly shoulders — bronze is just over half, while silver covers more than two-thirds.)
In the two years since, premiums have continued to rise. Obamacare’s opponents exaggerate the increases, while its defenders, equally helpful, point out that costs aren’t going up as fast as before the law existed. That’s no victory — and it’s not clear Obamacare is even responsible for that.
It’s true more Americans have health insurance now, thanks to the Obamacare alternative: a fine of up to 2.5 percent of your income for not having it. But it’s not clear Americans are any more likely to get the medical help they need, or that it’s more affordable, regardless of insurance.
A new study from health policy nonprofit Kaiser Family Foundation finds 63 percent of insured Americans with medical bills end up using “most or all” of their savings to manage the cost, and 42 percent needed to pick up an extra job or more hours to foot the bill.
“People with health insurance who have problems with medical bills also report skipping or putting off other health care in the past year because of the cost, such as postponing dental care (62%), skipping doctor-recommended tests or treatments (43%), or not filling a prescription (41%),” the study glumly adds.
Some hospitals will help —— if they feel like it
After the first bill arrived, we called the number from the flyer. It was for a different hospital, and we had to go online to get the right number. It was a bit hard to find, since the name of the program on the flyer had changed.
We found the “customer service” between the medical professionals and hospital bureaucrats like night and day — even at a nonprofit hospital. Where the doctors were warm and efficient, the billing department was cranky and disorganized. One woman gave us the cold shoulder when we showed up. Another snapped at us to sign in when we showed up 15 minutes early, and told us we had to wait.
The woman who did handle our case was more kind, but her computer wasn’t working and it took another 20 minutes to pull up our information. She wrote up a list of what we needed to bring to apply for financial assistance — which didn’t square with the list I had seen on their website, and had already tried to prepare. Guess that was out of date, too.
After collecting a year’s worth of bank statements, tax returns, a copy of our apartment lease, old mail addressed to my wife, notarized letters, and a notice from Healthcare.gov saying we applied even though it wasn’t an open enrollment period, we were finally told that the program only applied to the billing specifically from the hospital itself — about 60 percent of the total bill from the visit.
What about the rest, I asked. She said we were on our own to work that out. We applied anyway.
About two weeks later, we got a letter — a denial. It said we made too much money. The next day, the woman who helped us called and left a message: She was confident she could get authorization for a payment agreement which would knock around $7,000 off the bill, but we had to pay it quickly.
I felt guilty and angry then — but just angry now. We haven’t paid anything.
I’m dutifully repaying the $17,000 in student loans I took out for a graduate degree I didn’t finish. That was my choice, and I take responsibility. (I often think maybe we could afford insurance if I didn’t have student loans. That’s for another time.) But nobody gets ill on purpose, and we’re not going to pay an obviously highly negotiable $30,000 because we couldn’t afford to throw away more than $4,000 a year.
Higher deductibles and out-of-pocket maximums for the people who can’t afford them
Here’s the genius of health insurance: You pay insurers lots of money in the form of monthly premiums, and in return, they agree to consider paying for part of your care if you get really, really sick. (Obamacare also mandated some free services, including some screenings and vaccines, so at least you’re guaranteed something now.)
When you do get sick, you have to foot the bill until your deductible is met. A deductible is how much financial suffering you have to endure on your own, on top of the insurance premiums, before the insurer bothers thinking about paying for anything. And it can be thousands of dollars a year.
And once you finally meet that deductible, probably through some kind of harrowing health disaster, you may still be responsible for co-pays (a fixed price for a service) or co-insurance (a percentage of the cost) until you hit your plan’s out-of-pocket maximum, which can be as high as $13,700 for a family plan in the Obamacare marketplace.
The lower the premium, the higher everything else is. Health insurance is nothing more than a coupon. A very expensive coupon, which expires every year, and has dozens of pages of terms and exclusions. Wealthier people get better coupons, and use them more often.
Congress knew health insurance premiums would keep going up, even if they didn’t agree about the causes or amounts. And they knew the key to managing costs was to sign up healthy people who wouldn’t need to use their insurance benefits often. That means young people, who aren’t known for their wealth or worrying about their health.
Solution? Tell people they have to sign up and pay in, or the government is just going to take their money anyway. Then give them money to help pay for insurance, so you don’t have to take the money from them. Logical.
Instead of forcing the industry to offer a reasonable value of care, Obamacare offers tax credits to make outrageously priced plans less outrageous. But many — including me — don’t qualify for the subsidies, for various reasons.
Ironically, a lot of people don’t make enough money to qualify for financial assistance. These unlucky folks live in the one-third of states that refused to expand Medicaid, a government health insurance program that predates Obamacare, for political reasons.
“Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities,” Healthcare.gov says. (Sarah Palin’s so-called “death panels” are, in practice, Republican state legislatures.)
Obamacare was originally planned to bridge nicely with existing health programs like Medicaid, but Congress was far too inept and divided to pull it off. Obviously, the fact there are 33 million people still without insurance means there are a lot of gaps left.
Too much, too little, too late
There’s a completely different reason I don’t qualify for a subsidy: My employer already offers a mediocre health insurance plan. It has a $10,000 deductible — but Congress considers that both affordable and mandatory, and refuses to help me with it.
Because the plan would cost slightly less than 8 percent of my annual income to cover just me, I can’t get help. Even though the price more than doubles when I include my wife, who is an independent contractor and also needs coverage.
In order to get an Obamacare tax credit to lower the cost, the law requires that the crappiest plan available to you cost more than 9.5 percent of your income. The real kicker is this: You’re completely exempt from the legal requirement to buy health insurance if the cheapest plan costs more than 8 percent of your income.
We’re stuck in this tiny gap between not having to have insurance the government considers unaffordable, and not being eligible for help paying for what the government considers affordable.
And while it’s moot for me personally, it doesn’t help that the enrollment window for Obamacare and for my employer’s plan don’t overlap; they’re about three months apart, making price comparison difficult. That’s yet another cost-related problem Obamacare doesn’t deal with.
Credit bureaus are doing more about medical debt than Congress
Despite all my complaints, I think we’re the lucky ones. My wife is an immigrant and didn’t have any credit to wreck with an unexpected hospital bill. When she initially got here she wasn’t legally allowed to work for months — great work on modernizing immigration laws too, Congress, by the way — so even after getting married we just put things in my name. I made her an authorized user on my credit card so she could start the long process of building credit.
My credit score is safe from what’s technically her medical debt, so we have a little stability. Until I get really sick or injured, at least. Then it will all fall apart, just like Congress.
A bad credit score can make a lot of things more difficult or expensive, including buying a home, renting an apartment, leasing a car or buying one with an auto loan. Even cell phone service requires a credit check.
Medical debt is the most common kind of debt in collections, affecting the credit of more than 43 million people. Fortunately, last year the credit bureaus decided it should be treated differently than other kinds of debt because it’s not willingly taken on.
They’re making a few changes to how medical debt factors into credit scores, including ignoring it for the first 6 months to give insurers and doctors time to sort out their paperwork and disputes without hurting consumers. They’re also removing the bad marks associated with paid medical debt, which would otherwise linger for up to seven years.
Separately credit scoring company FICO decided to reduce the impact of medical debt on its scores, which are the most widely used in the industry. VantageScore, a rival scoring model created by the credit bureaus, did the same thing.
These changes were likely spurred by the Consumer Financial Protection Bureau, which a few months earlier released a report documenting the impact of medical debt on consumers. At least one big thing Congress created in the past decade is going right.
Article last modified on May 1, 2017. Published by Debt.com, LLC .