Sunday, November 10, 2013

Why the Affordable Care Act is Important


When I was in college I worked for a company that offered insurance to all employees who worked 35 hours a week or more. This did not include me because I was only working 20 hours a week and I was on my parents insurance at the time. A few months later, the company decided to give the employees a stipend to buy their own single coverage health insurance and let the employees purchase dependent insurance on their own. They decided to only provide a stipend for the employee coverage because if they paid a larger stipend for employees who had dependents, this would #1 – cost more money, and #2- cause the single employees to revolt, and #3 – were concerned that it may be considered discriminatory In my opinion, it was a huge mistake – the majority of the employees didn't purchase insurance coverage at all – not even for themselves! They smoked the money up on stupid stuff. They took a chance that they could buy health insurance next month, or the month after that, or “when I really need it”. Well, this was back in the day before HMO plans, which allow pre-existing condition coverage. Most health plans were just major medical add/or medical visits and prescriptions. So, the day comes when they really need health insurance and either they have nothing in place at all or learn that their condition won't be covered at all by the plan, or they learn that the coverage they bought on their own has so much fine print and exclusions, it barely covers anything other than a hospital stay.

MEMO TO SELF – People have a hard time understanding the benefit of intangibles like health insurance unless they are in need of the coverage right then, and usually that is too late. Don't leave it up to people to buy their own insurance, it's not going to go well.

Now, you may say that those employees are grown and should be able to sink or swim on their own if that's what they decide to do. I would agree with you under normal circumstances, but unfortunately people don't act out of their best interest in some cases. Despite the copious training, the Q&A sessions, and insurance fairs that were held, only 20% of the people used that money to get coverage for themselves and/or their family members. People started leaving the company because they needed a job that offered health coverage for their family members. Employees who neglected to get coverage for themselves disengaged and checked out, literally or figuratively. They started to complain about the “skinflints” who ran the business. Why were they such tightwads that they couldn't afford to give health insurance. Employees started to see first hand why insurance was so important when they encountered health issues. If you took a Libertarian view, that's what freedom is all about. In my opinion, life is too precious to take a chance with.

Eventually, the owners sold the business to another company, and the new company resumed offering health insurance in the traditional manner. Order was restored. I see a wave of this happening in the coming months because a lot of companies do not realize how detrimental it will be to eliminate health insurance coverage or drop employee hours below a certain threshold to forestall compliance with the Affordable Care Act. I've been asked about this issue a few times, but I believe that companies that are committed to remaining in business will continue to offer full coverage insurance. While it's tempting to say I'll just pay the fine the government plans to impose ($2,000 per employee per year) if no coverage or substandard coverage are offered, or I'll just let my employees buy their own coverage. Realistically, there is more to it than just handing out some stipend checks and the phone number to the local Affordable Care Act info center or website. If you or a family member became ill without coverage, I'm pretty you'd want to do everything you could. Unfortunately, in a case where you've done nothing, there is nothing to be done.

For those people who found that their health insurance was cancelled as a result of the enactment of the Affordable Care Act, let me illuminate a fact. The point of healthcare reform was to eliminate health care plans that were substandard. If you had a plan that only covered hospitalization, and didn't cover prescriptions, emergency room visits, or therapy – your insurance plan was not going to be saved anyway. The insurance company can't make money selling a product that is no longer allowed. You shouldn't have called that health insurance anymore than SR-22 auto insurance is quality auto coverage – it's barebones coverage that is lambasted in Allstate commercials. Insurance companies have to offer standard plans that include hospitalization, doctor's visits, therapy sessions, prescriptions, and emergency room visits now. Some people saw their insurance costs increase because the standards have been raised. I don't believe those plans should come back, its time to move on to something substantial.

If you live in a progressive state like Illinois, you have the option of selecting a plan from the State of Illinois offerings and you may even be eligible for a subsidy to pay for a portion or all of the coverage. Having seen the coverage offerings, I would suggest that you take the time to choose wisely for yourself and family. You don't have to make a decision today. As long as you enroll by the end of March, you can participate. If you aren't in a progressive state, there are sure to be some protest rallies to get your state legislature to offer insurance plans that partner with the Fed to help subsidize coverage. Please get out your comfortable shoes and attend a rally. Don't miss the chance to get health insurance coverage for yourself or your family during this historic period. As the Vice President, Joe Biden said “It's a big f___ deal!”

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