Affordable Healthcare Act – Affordable For Whom?

Cost of HealthcareOpen enrollment for healthcare has ended as of January 31st with nearly 13 million people enrolled. It is time for a gut check. As my friends and family share their experiences with obtaining healthcare, I have come to the conclusion that affordable healthcare is not so affordable for all.

The ACA is a blessing for those less fortunate that do not have healthcare provided by their employer and must obtain it through the health exchanges. Their entire health insurance premium is paid by taxpayers and they in turn pay very little for doctor visits and medication. A much better blessing is employee sponsored healthcare with very little cost to the employee. One of my sons has the former while the other has the latter option. So I have an intimate knowledge of both of these options. I am thankful and grateful that they both have health coverage at this time.

However, it is an entirely different story for others. My working class friends have struggled to pay their premiums. They are freelancers, contract workers, self-employed workers that make too much to be subsidized but not enough to comfortably afford to pay for healthcare under the Affordable Healthcare Act. Still other friends who could afford to retire early now find healthcare is making their early retirement unaffordable. Yet another friend who lost her job and benefits found herself in a similar position too. Her husband works for a small company and to add her to his employer health plan was too expensive. With the one remaining income they could not afford to purchase insurance for her through the exchange and the husband made too much money to get subsidized. Therefore, they made the tough decision for her to go uninsured until she found another job. They too simply could not afford the “Affordable” Healthcare.

In January 2015, the Gallup-Healthways Well-Being Index found that the law’s progress stalled last year. The share of U.S. adults without health insurance was 11.9 percent in the last three months of 2015, according to Gallup, essentially unchanged from the start of the year.

So what options does one have?

If you elect to remain uninsured, you can go to the doctor and pay as you go and join various medicine plans provided by your local pharmacy. But this comes with a hefty penalty from the government. In 2016, the penalty is $695 per adult and $347.50 per child, or 2.5 percent of household income, whichever is greater.

You can purchase limited benefit policies such as short-term, critical illness, accident, dental and vision plans that could meet your heath needs at a lower monthly cost. However, these Do-It-Yourself plans do not qualify under the current health law. They do not meet the minimum standards required; therefore you will still be subject to the penalty. You must have comprehensive coverage.

In 2014, when the provisions of the health law took effect, the number of people applying for short-term plans rose 130%, to 147,383, at online health insurance vendor eHealth. The average lump sum payout for this type of insurance is $31,000 and will not come close to covering serious illness treatment.

There is no wonder that 28% of voters say paying personally for healthcare and health insurance is a very important issue in the upcoming election.

The last option is Direct Primary Care. Once considered health care for the billionaires, doctors are offering the service to their middle-income, Medicaid and Medicare patients.

These doctors bypass the insurance companies and offer health care for a flat monthly or yearly fee. The patients pay these fees directly to the doctor and it includes comprehensive primary care, medication, lab tests and follow-up visits. The 2010 health law accepts direct primary care as a viable option. The consumer will still need to acquire a high-deductible health plan for specialists or emergency care. However, the number of doctors participating in this type of program is very small.

As I feel that affordable healthcare should be available to all whether rich or poor or somewhere in-between, the self-employed and working class should not unfairly bare this burden alone.

With all the available alternative programs out there I am hoping our government will recognize some of them or come up with a viable resolution to more fairly balance the cost of Healthcare so no one has to choose to go without.