By JPANDS, Special for USDR
While the Affordable Care Act (ACA or “ObamaCare”) promised superior coverage at lower cost, the reality is that millions who lost prior coverage will be paying more and getting less value, writes New York neurologist Lawrence R. Huntoon, M.D., Ph.D., in the summer issue of the Journal of American Physicians and Surgeons. http://www.jpands.org/vol19no2/huntoon.pdf
For the millions who qualify for generous subsidies or expanded Medicaid in ObamaCare, the affordability of paying little or nothing for their health insurance “will be revealed as nothing more than a cruel hoax when beneficiaries discover that coverage is not the same as timely access to good care,” Huntoon states.
Although plans in the lower “metal tiers” have high deductibles, the significant financial benefit previously associated with choosing a high-deductible health plan (HDHP) to accompany a health savings account (HSA) has been reduced and nearly eliminated. Premiums are disproportionately high, in order to subsidize premiums for high-risk persons and to increase insurers’ profits.
The structure of ObamaCare’s deductibles, co-pays, and out-of-pocket maximums is designed to essentially eliminate out-of-network medical care. Out-of-network deductibles are not only much higher than in-network deductibles, but the two may not be combined in calculating whether one has met the deductible. Since few people pay more than the sum of the two deductibles in a year for medical care, the existence of “coverage” is an illusion.
Good, timely medical care may not be unavailable in-network. But, in the new ObamaCare plans, where one may continue paying as much as 50 percent co-insurance with no upper limit, there is no protection from financial ruin if one goes out of network. The whole purpose of insurance—protecting one’s financial assets against unpredictable costs—is lost.
Physicians are at higher risk of financial loss if patients, accustomed to low copays, are reluctant to pay their deductibles, or if patients simply stop paying premiums and demand free treatment from physicians during the last 60 days of a 90-day grace period. Insurers face no penalty for failing to provide physicians with timely information on coverage. This risk, combined with the higher administrative costs imposed by ObamaCare, will likely lead many physicians to decline to participate in ACA-compliant plans.
ObamaCare destroys patient choice and often disrupts continuing long-term patient-physician relationships,” writes Dr. Huntoon. “By implementing extremely high deductibles, co-pays, and out-of-pocket maximums, ObamaCare creates the illusion of coverage at the cost of unacceptably high premiums. This combination represents the largest wealth-transfer program in our nation’s history.”
The Journal is the official, peer-reviewed publication of the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties, founded in 1943 to preserve private medicine and the patient-physician relationship.