Access to health insurance does not mean access to any healthcare or the quality of the healthcare we get. This important truth notwithstanding, reforming the health insurance industry to empower people who need medical care and to increase access to health insurance are certainly a start in our shared goal of taking care of our family’s health needs.
The Affordable Care Act has now been if effect for its first week. The focus of the entire healthcare reform process which led to the so called “Obama Care” and/or ACA, has been political infighting and the protection of state budgets who fear getting saddled with another Federal Government mandate that burdens local government budgets and makes current state administrations justifiably nervous and cautions in these times of economic hardship and post recessionary hangover.
Whatever the politics or problems, the Affordable Car Act is now the law of the land and getting to understand how it works and evolves will all of us to support families and children who need the services this law makes possible for those in need.
“…much has been done to simplify the process under Obamacare:
People will be able to apply for advance premium tax credits in exchanges in a variety of ways, including online, by paper application, and over the phone through call centers. There is a standard paper application, which is three pages plus appendices for individuals and longer for families.
Plan choices will be arrayed online based on where you live. A standard, short summary of coverage will be provided for all plans. This will explain covered benefits and cost sharing and provide illustrations of how coverage would work for common medical events, such as having a baby. This summary will make it easier for consumers to compare plans. When looking online, consumers are expected to be able to sort and compare plans based on the standard coverage elements they care most about.
All insurers will be required to cover mostly the same benefits, including some services that are often excluded or limited today for people buying their own insurance (e.g., maternity care, mental health, and prescription drugs).
Coverage will be standardized into tiers (from bronze to platinum). Deductibles and copays will typically vary from plan to plan, but all plans in a given tier will provide the same overall level of protection to consumers.
But, probably the single biggest step to make buying insurance simpler than today is the prohibition of what’s known as “medical underwriting.”
Now, in all but a handful of states, insurers request detailed information about your medical history when you seek to buy insurance on your own. If you have a pre-existing health condition, an insurer will generally either refuse to sell you coverage or charge you a higher premium.
Not surprisingly, this makes insurance inaccessible for people with serious medical conditions, such as cancer, heart disease, or HIV/AIDS. In addition, as a study we did shows, even people with relatively minor ailments — like hay fever or a knee injury that was previously repaired surgically — can face challenges. This study was done more than a decade ago, but there’s no reason to believe that the findings are not still current today.
As the table below shows, 18% of applicants are denied coverage in the current individual insurance market (not accounting for those with pre-existing conditions who do not try to apply). This varies significantly across states, from 0% in a handful of states that already require insurers to accept all who apply to 30% or more in other states.
Medical underwriting not only makes insurance less accessible for people with pre-existing health conditions. It also makes applying for insurance much more complicated for everyone. Consider, for example, the standard insurance applications in Illinois and Wisconsin. (These particular applications are easily accessible online, but they are not at all out of the ordinary.)
The medical history and lifestyle questions go on for 5 pages in Wisconsin and 6 pages in Illinois, including questions such as:
Over the last five years whether you have been diagnosed with or treated for any of several dozen medical conditions. These range from ear infections, strep throat, hay fever, and eczema to cancer, hepatitis, diabetes, and bi-polar disorder.
The dates and details of treatment for any medical conditions, including lab results (e.g., cholesterol levels) and the name of the treating physician.
Whether you’ve received (or been recommended for) treatment for drug or alcohol abuse.
Whether you participate in dangerous or extreme activities like motor racing, bunjee jumping, or scuba diving.
Medical underwriting creates several challenges for consumers.
Most obviously, it means that people with pre-existing conditions can’t get insurance or face higher premiums. A recent Kaiser Family Foundation poll found that 49% of Americans under age 65 say that they or a family member has a pre-existing medical condition. Among this group, 25% say that they or someone in their household has been denied coverage or faced a premium surcharge because of a pre-existing condition.
It also makes the process of applying for individual insurance today difficult and time-consuming for many. And, because a consumer has no way of knowing what premium an insurer will charge until the application process is completed, it is quite hard to comparison shop. Benefits also vary across insurers in complex ways that make it tough to compare what value one plan offers versus another.
This all changes starting October 1. With no medical underwriting, largely uniform benefits, and standardized tiers of coverage, consumers should have a much easier time applying for insurance and comparing prices. Consumers will have to make tradeoffs between the level of the premium, the degree of patient cost-sharing, and the breadth of a plan’s provider network, but they will have access to information to help make those decisions.”