Healthcare Rip-Off: Is It Affecting You?

NEW YORK (MainStreet) — For January 1, 2014, you will likely be required to purchase health insurance in the most expensive healthcare state in the world. Ignoring this mandate could result in a costly fine. That is the bad news. The good news is this mandate comes with a plan to provide healthcare to more U.S. citizens, and it's called the Affordable Care Act.

See the nonpartisan Kaiser Family Foundation explain it in this informative cartoon.

Maribeth Shannon, director of the market and policy monitor program for the California Healthcare Foundation (CHCF), also explains that the Affordable Care Act opens up opportunities by "prohibiting health insurers from denying people based on their health status" and creating "a market place where people can choose from a number of options for coverage that seems to suit them."

 

Enrollment opened October 1, 2013, and if you haven't already, you will have the option to enroll in the Health Insurance Marketplace. Here's what you need to know:

  • Every plan will cover core "essential benefits," such as hospitalization, prescription drugs and maternity care
  • You will be able to compare the prices, benefits and quality of each plan before purchasing
  • It will inform you of whether you now qualify for free or low-cost care through the Medicaid expansion
  • Coverage starts January 1, 2014

Shannon also appreciates that the plan is an "attempt to try and control the cost problem." "There are things like innovative...delivery systems...where you have hospitals and medical groups and health plans all working together to try and take care of people in a more integrated, systematic kind of way," she said.

The Cost of U.S Healthcare

Concerns about national health coverage and cost predate the Great Depression, starting with Theodore Roosevelt's Bull Moose Party campaign in 1912. From the proposal for National Health Insurance with the New Deal to Bill Clinton's failed Health Security Act (which sounds similar to President Obama's plan), the topic of health costs has always been a hotly debated sore spot.

One thing that can't be debated...

Healthcare in the U.S. is expensive:

  • Most personal bankruptcies are filed due to medical costs.
  • The average out-of-pocket expenses for an uninsured person are $26,971.
  • About 50 million Americans today are uninsured.

As to what makes U.S. healthcare so expensive, Shannon sees it as a combination of patients, doctors and other care providers "who aren't paying enough attention" to the factors that contribute to high costs. Health care providers should be educating consumers on possible cost-effective choices like taking generic medicine instead of the brand-name variety.

California Attempts Cost Control

The CHCF's home, the State of California, has undergone its own attempt to reform health costs for the uninsured, this one specifically aimed at hospitals:

From The U.S. National Library of Medicine (PubMed):

"In 2006 California approved "fair pricing" legislation to protect uninsured patients from having to pay full billed charges. We found that by 2011 most California hospitals had responded to the law by adopting financial assistance policies to make care more affordable for the state's 6.8 million uninsured people. Ninety-seven percent of California hospitals reported that they offered free care to uninsured patients with incomes at or below 100 percent of the federal poverty level."

And while the California Fair Pricing Law has gone a long way to make this sort of care more affordable, it may still hurt the uninsured a great deal. The law itself does not offer help but to those 350 percent over the poverty line, and even with it intact, consumers are still on the hook for what Medicare would have paid, which Shannon says "can be expensive."

Nevertheless, PubMed reports, "California's approach offers a promising policy option to other states seeking to protect the uninsured from receiving bills based on full billed charges."

A Final Word

As legislation initiatives like California's Fair Pricing Law bear fruit, and with Obamacare taking full effect in 2014, millions more Americans can expect to receive care through protective policies. Until then, Shannon would urge those without insurance to do the necessary research to save the most medical dollars.

"I would encourage people to make sure they need the service, then if they do, they need to know they can negotiate," she said. "If they are uninsured they should talk to the hospital [and] compare hospitals to see which can offer the best discount policy."

--Written by Jean-Marc Saint Laurent for MainStreet

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