When the Affordable Care Act was passed, I was overwhelmed by the sheer breath of the legislation. It was not merely an act that addressed health insurance, it affected individual and employer taxes, electronic medical records, assistance for community health centers, physican education and funding and extensive regulations as per employee benefits. The scope of this law is overwhelming. I see great difficulty unraveling this web of legislation as quickly as the Republicans hope.
If the current Republican plan goes forward, we will definitely see winners and losers. From a cost perspective, Millennials will see a reduction in premium levels while Baby Boomers will see hefty increases. To get at these increased costs, Republicans want to narrow the essential benefits contained in a health plan. Currently there are 10 essential health benefits that all qualified health plans must contain. The benefits are:
- Emergency Room coverage
- Outpatient Care
- Annual routine physicals
- Your prescriptions
- Coverage for mental health and substance abuse.
- Your lab tests
- Treatment for Hospital inpatient care
- Treatment for physical, speech, and occupational therapy.
- Pre- natal and post natal care.
- Pediatric dental
In addition to these essential health benefits, health insurance plans are required to have each plan limit annual out of pocket expenses to a maximum of $7,150 and the plans must have unlimited coverage with a maximum deductible of $7150. Furthermore, each State may require that insurers cover other conditions the Federal guidelines do not address such as coverage for Autism.
Do you think these mandates are free? No. Each mandate has a cost and for all of us this adds to our monthly premium cost. Do you think having an out of pocket maximum of $7150 raises your monthly premium? Prior to the Affordable Care Act, many individual had deductibles of $10,000 and Out Of Pocket Maximums of $10,000 and $15,000. Under the current ACA law, the deductible is included in the Out Of Pocket Maximum. Prior to the ACA, the deductible was NOT included in the Out Of Pocket Maximum.
Who Should Spend Your Money?
Here is what this whole controversy boils down to –someone else is spending your money. The state and Federal Governments by virtue of mandating benefits and plan designs have increased all of our monthly insurance costs. We have no say in the matter, it is simply the law. However ,there are certain groups that have been given exemptions from including mandated benefits in their health plans. Christian Health Sharing plans are exempt from the Federal mandates of the ACA .In fact, these plans even apply pre-existing condition clauses which are also outlawed under Obama-Care. This is an alternative that should be open for all of us not just for specific groups.
The bottom line is that most Americans have had significant choices made for them by Government bureaucrats who refine and write the regulations. These folks are imposing a lot of what they feel is important on you without actually having to pay the cost themselves. It shows up in your premiums.
We loose significant cost savings as a result of mandating benefits into insurance plans. Why not let each family or individual decide what they want and can afford? There will be no perfect choice for everyone, we all understand that insurance has its’ limitations: be it life insurance, homeowners insurance, disability insurance or dental insurance. There is no perfect. What we are looking for here is something that is affordable for families and individuals. Most families struggle to purchase health insurance because the monthly cost is so high. We need options and lots of them, we do not need narrow pricey plans that are loaded with benefits we might not need and can’t afford.
As I see things right now, I think the Republicans and Democrats need to focus on what affordable really means to families and individuals. Just like we buy cars and homes, most of us are intelligent enough to figure out what we need and how much we want to spend? Shouldn’t we have the same options with health insurance?
