Thursday, March 4, 2010

Fathoming Obamacare

I really, really want to understand President Obama’s health care proposal. By all indications, a reconciled version of the House and Senate bills, mixed in with the president’s latest proposals, will be sent through Congress and likely adopted. I want to know what all that means for me and my family.

Answers to that question are hard to find.

That the status quo needs to change is obvious.

I buy insurance for my family. It’s an okay policy, but not the best out there. We paid the premiums for two years without a claim. Then the insurance company wanted a price increase. No claims on our part, but the “cost of business” has gone up. So we threw a hissy fit and changed policies and still ended up paying more.

Last Thursday, our youngest boy burned himself falling onto the woodstove (the little idiot was tap dancing on the ping-pong table, fell, and landed on the stove). First we took him to a local private clinic, but because we had the effrontery to have an accident ten minutes before closing time, the doors were locked and the envelope-licking lackey inside was unresponsive to my wife’s door knocking.

The local hospital was just up the street. But did we want to put in a claim and see our premiums soar – we already know what they do when we pay the bill and DON'T USE THE DAMN INSURANCE. So thanks to a few savvy moms in the neighborhood and a nephew who has just finished CNA training, we self-medicated. He’s doing better now.

I would love to have better insurance options. The problem with the current health care bills is that no one – and I mean no one – is doing a good enough job explaining to schmoes like me why the proposed bills will do us any good.

The national media gets failing grades in this respect, and it’s shameful. I’ve yet to see an “in-depth” explanation of how any of the bills will help me and my family. They typically boil down their explanations to maybe sixty to ninety seconds of bullet points: You’ll get tax credits based on the percentage of income you spend on health care! Deficit reductions due to the reforms! This will make your health care more affordable! Those on Cadillac plans will pay taxes to help out the poor schmoes! And then they spend much more time on the politicking of health care reform, rather than telling me, the average American, why I should be excited about it. The media is much more intent on painting the Republicans as the Party of No and as obstructionist and as in the pocket of insurance companies than telling me why I should be excited about the proposed reforms. You’re failing me, mass media. Get off the politics and tell me what’s going to happen if these reforms go through.

What’s even worse is that the White House isn’t doing much better. I’ve spent a lot of time reading what information the White House is offering on the bills, on reconciliation, and on Obama’s proposals and I still don’t know much more beyond what the pretty boys and pretty girls of the media are telling me.

So there are tax credits. Based on income and the amount of money I spend on health insurance, will I qualify for them? I don’t know. The information at is too vague for me to decide. My interpretation tells me that to qualify for the credits, I’d have to spend between 8 and 9 percent of my income on health insurance costs. Right now, I pay about 5 percent. So to save money, I have to spend more money? No wonder y’all can’t sell this. But if I’m in error, the only way to find out is to submit an e-mail question that’ll take who knows how long to get a response.

Here’s the information I’m getting:
The Act will provide the largest tax cut for health care in American history. Millions of families will receive hundreds of billions of dollars in tax credits to help them pay for insurance in the new exchanges. This tax relief for working families will make insurance more affordable for those who can’t get it through work or whose employer insurance is too expensive.
I pay about $3,360 a year in premiums. As a percentage of income, that equals about 5 percent. Now, I don’t exactly have a Cadillac plan – more coverage would be better. But unless the tax credits pay for a significant portion of the increased amount of money I’d have to spend to qualify for them, I just don’t see the use. The percentage I’m using, as provided by the White House, is for a family of four. We’ve got five. Maybe that’ll make a difference, but from what I’m being shown, I can’t tell.

Then there’s this:
Both the House and Senate bills include significant reforms to make insurance fair, accessible, and affordable to all people, regardless of pre-existing conditions. One essential policy is “rate review” meaning that health insurers must submit their proposed premium increases to the State authority or Secretary for review. The President’s Proposal strengthens this policy by ensuring that, if a rate increase is unreasonable and unjustified, health insurers must lower premiums, provide rebates, or take other actions to make premiums affordable. A new Health Insurance Rate Authority will be created to provide needed oversight at the Federal level and help States determine how rate review will be enforced and monitor insurance market behavior.
As a subcontractor to an outfit that contracts work for the federal government, I’ve seen firsthand how well bureaucracy does in saving money, and I don’t say that facetiously. For the most part, the system works. But there are instances where the bureaucracy causes expense, rather than cutting it, so I’m wary.

And then there’s this:
Every member of Congress will be required to purchase their insurance from the new health insurance exchange.
Big deal. They make more money than I do and, as a consequence, can afford better health care. To put us on equal footing, they should also be required to give up their lifetime pensions, with which they can pay for their insurance.

Then I see this nifty little feature. Wow! I can see what “reform means to me!” So I answer the question: I buy my own insurance. I get this answer:

• You will likely pay less---perhaps much less. If you buy coverage like you have today on your own, premiums are expected to drop by 14 to 20 percent. If you get coverage through your job, premiums could decline by up to 3 percent.

• In addition, many Americans buying coverage in the individual market will qualify for tax credits that reduce their premiums by an average of nearly 60 percent – and they will get better coverage than what they have today.

Likely and many. It’s still too vague.

And, yes, this is what it comes down to. Show me the money. Because right now, if my wife or a kid needs to go to the hospital for an urgent need, I'll take them there, lousy insurance or not. If Obama's health care proposals will make that less of an agonizing choice, or make it easier for us to afford, say, dental insurance, or make an occasional visit to the doctor not so much of a financial burden, I'm all for it. Whether my congressmen have to buy insurance from the same pool, or whether the government will work to make forms easier to understand (they've certainly done a great job of this at the IRS) isn't important to me. What I want to know is will this make better insurance more affordable. At this point, I get the vague understand that, yes it will, but until I see the numbers, I don't know to what extent that affordability will extend.
So I submitted my e-mail to the lackeys at the White House. I’ll post updates as they arrive.

UPDATE: The Kaiser Family Foundation has a nonpartisan explanation of the various health care proposals that is actually helpful. Incldued in this link is a calculator that'll show how the tax credits work. It appears under the Obama plan we would qualify for about $3,300 in tax credits -- but that's on yearly premium payments of about $9,000 -- far more than we pay now. Admittedly, the policy picked for this calculator is a bit more on the Cadillac side than what we've chosen for ourselves. Still, it shows a tax credit would be there.

But how is it going to be paid for?

Ah. Here again from the Kaiser Family Foundation. Savings in Medicare and Medicaid. Penalties on companies and individuals who opt out of insurance coverage. And taxes on the rich folks.

This brings me to the second bullet point above: Better health care for my family through these plans. Sure, that appears possible. But I can get better health care now if I just pay more. And by all estimates, if I want better health care under the proposed plans, I have to pay more. Maybe not as much as I would outside the plans, but still more. And since the difference is made up in tax credits, which we get back with our income taxes, we still have to come up with the additional money to pay for the fancier care and then wait for a reimbursement. Maybe that makes for easier accounting, but since premiums are paid on a monthly and not a yearly basis, it still makes it tough on the ol' coconut.

I should note that I found this information thanks not to any national media outlet, which are still, in general, focusing on the politics, but thanks to a local news station which did a story on local college students studying the plan. Thanks, Local News 8.

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