My View: Taking a closer look at gotchas of ObamaCare |

My View: Taking a closer look at gotchas of ObamaCare

Felicia Muftic
Courtesy Photo |

The GOP hyped their anti ObamaCare crusade with some gotchas recently. One is “Aha, the President lied” about Obamacare (ACA, Affordable Care Act) when he promised “if you like your insurance, you can keep it.” The other is “the website does not work.” Gotchas? Maybe not so much.

When the President first made those promises in 2010, he was not lying. If your individually purchased policy in 2010 when the law was passed was the same now, you get to keep it if you want to. However, in the small print, if there were any new policies issued or changes after March 2010, you would have to either upgrade it to meet new standards or find another one.

The other gotcha is the federal website does not work, but most concede that it eventually will. Remember, too, Colorado runs its own marketplace and site and it is working. As of Oct. 25, Connect for Health Colorado saw 44,935 accounts created and 3,164 people enrolled, not including Medicaid enrollments. This even beats the first month’s experience of Massachusetts, after which ObamaCare was modeled.

,The individual insurance issue may not be a big deal for most of us, but it is a big deal for those individuals affected. Some are understandably livid. An estimated 8 million of the 12 to 15 million who had bought insurance individually got letters recently from their insurers dropping their insurance or raising their rates because the old policies did not meet the new standards required by ObamaCare. Those impacted are about 5 percent. The rest of us, over 200 million with Medicare, Medicaid, employer provided insurance, are not.

What may be of consolation to many of those who got the drop or premium increases notices, is that they are not left without insurance. The new policies are comprehensive, unlike their old policies, called by some as “ Swiss cheese full of holes” or “junk,” as Consumer Reports called most of them in March. An estimated 50 percent of those dropped will qualify for subsidized premiums in the exchanges and pay less and get a better policy for their money. The rest can have access to the exchanges which function much like large group policies and could even offer a better deal. Shop first in the exchanges to get a grip on the alternatives.

The minimum provisions now required to be included in all insurance policies are ambulatory patient services. emergency services, hospitalization, maternity and newborn care, mental health and substance use services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and annual checkups and cancer screenings, chronic disease management, and pediatric services, including oral and vision care. There are also consumer protections in the new standards, such as forbidding caps on the amount of coverage, denial because of pre-existing conditions, dropping coverage when you get sick or are in the middle of treatment, charging more for women, outrageous out of pocket co pays and deductibles, and administrative costs exceeding 20 percent of the policy spent on actual services.

Those liking their old policies may never need all of these basics such as maternity and child coverage, and they treasure their right to gamble they will never need others .Their right to buy under-insurance is indeed trampled, but the Supreme Court upheld the individual mandate over other rights. All need to be in the pool to make any of the advantages of the law financially feasible, including covering women’s health needs without charging them more, which has been the case in the past. Grandfathering in substandard policies may be one of the tweaks that could be considered by Congress..The issue then becomes the impact on financing the law’s implementation and how to make up the difference with a “pay for”.

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