Last month, we dealt up-close-with the broken, ill-conceived system that is supposed to be helping people get health insurance.
N.B. This is not an advertisement for/against either Democrats or Republicans. I am philosophically committed to the notion of not being a proponent of any political party or system. This rather succinct diatribe comes after multiple, personal (non-partisan) experiences of how inept the current health care system can be.
The Department of Human Services in the state of Arkansas has a seriously disabled ACA-associated arm, we found out. The end for us came a year after we moved away—and after multiple letters and phone calls over a period of months. We had moved out of the state, told them so several times, and they repeatedly missed that key fact and were trying to charge us thousands of dollars for insurance for which we could not have qualified if we tried. Arkansas simply could not get its records straight, and we were eventually told we had a hearing, and we had to retain an attorney who rolled his eyes along with us and shut them up. One sensical soul at the AR DHS, a foreigner who had a clear head and could communicate realities far better than the native Arkansans we dealt with, finally helped put the matter to rest. I think Arkansas DHS should pay our legal expenses and have asked for same, so far without response from the appropriate sub-department.
On the other hand, the state of Kansas did its job well, as far as we could tell. We got a single-coverage medical policy cheaply for a year and a half, but the degree to which Federal red tape and impossible processes were involved was impressive—even to one who starts from a point of skepticism about any government’s or big business’s ability to do much of anything well.
We were informed by letter, smack-dab in the middle of our 2nd year of a policy for our son, that we no longer qualified for that policy. We had anticipated that we’d have to pay more after a year in order to keep the same plan for our son, but we were renewed, so it came as a shock that were booted out altogether about five months later. The letter said, and I quote, “You can reapply at any time, but the “anytime” part turned out to be false. We quickly found that the “Marketplace” (which is fettered, not free) actually prohibited us from applying until after the first policy had expired. Yes, you read that right. We had to wait eight more days, on the first day our son would be uninsured, in order to apply. In other words, it was not possible, within the system provided, to satisfy the requirements of the same system. This scenario is as illogical as it is frustrating, in case you were wondering.
Upon investigation on the day after the first policy had expired, my wife found that the options available to us began with a policy that (a) cost nine times as much as we had been paying and (b) covered almost nothing. Specifically, an insured person would have to pay the full price, “out of pocket,” for any service, including prescriptions or doctor visits, until the massive deductible was met. There were no better options for sale in this marketplace.
Next step: I went back to my employer’s plans, one of which covers my wife and me. Currently, we pay approximately 1/3 of the total cost of our own insurance, and my employer covers the rest of the group-rate premium. The rates for adding an additional family member increase dramatically, though—to the point that the deduction from my paycheck to insure three people would be equivalent to half of my take-home (net) pay. This is a non-starter for us. (I do not lay the blame at the feet of the benefits plan devised by the employer. In general terms, I would tend to blame corporate greed and medical litigation for the now-insane costs of medical insurance and services.)
Next, I made a couple of calls to local insurance agents. One didn’t answer. No message left. Another referred me to yet another who did sell the type of policy we needed. I was already thinking about having our son go uninsured and paying the penalty, but, in talking to the next agent, we learned that President Trump’s administration had done away with the penalty. Okay, that’s good, but we’d still rather have our son insured if we can. We were then faced with choosing from among 36 three-month policies that feature various combinations of high deductibles, out-of-pocket-maximums, and premiums that were relatively affordable but still 2-5x more than we had been paying. In our case, we will almost certainly never reap any benefits from this medical insurance unless we have a catastrophic need—an event that would surely bankrupt us, anyway. We now have to reapply every time the three-month policy expires, to boot.
Now, to put this insurance product in perspective with need and perceived worth. All three of us have been to a physician for sickness precisely zero (0) times in 18 months. Our son went to the doc for a free children’s checkup last summer, and I “took advantage” of insurance for physical therapy. The insurance covered about 40% of the total bill. Not very good insurance, I would say, but we are blessed with the ability to pay the rest, so it was OK. Yes, 40% is better than nothing. I only hope that if any of us is ever hospitalized, the insurance will pay more than 40% of that bill.¹
In going through all this in my mind, I do wonder about the potential benefits of socialized medicine. I’m not interested in moving to Canada or Europe or wherever they have different systems, but if any of us ever need surgery, I imagine we’ll investigate international travel. In the meantime, until something breaks, it appears that we’re stuck with paying too much for two “major medical” policies that we’ll likely never use.
¹ I also hope the bills come from one place if services are rendered in one place. In the case of my physical therapy, I saw an orthopedist, had an X-ray, and had the physical therapy itself in the same building, and separate bills came from three or different offices. There was a separate fee for the outsourced radiologist “reading,” which could have been accomplished just as well by the orthopedist but had to be sent out to another because of some insurance-related agreement.