The ACA Exchange Connundrum

I have a friend, lets say she is in her 50s, a single mom and has been out of work for quite a while. She created her own business through hard work but has been unable to purchase insurance for a while.  She has one adult child that lives at home with her. I believe that she deserves affordable insurance and that she has a right to coverage regardless of her disease state.  From time to time, she gets frustrated with my positions on ObamaCare thinking that I am advocating for its repeal and that even the changes I speak of will harm her ability to get affordable insurance. This is not the case, but I can understand how she feels and why she feels this way. It is my friend and many others like her that need the very sections of ObamaCare that I think should stay in place and this is why I do not support a blanket repeal.

She is a very good person, intelligent and industrious. She is a strong supporter of ObamaCare. When Covered California, opened yesterday I went to the site to see what the new deal will be for people like my friend. It took two attempts to get into the site, although it was not a long wait, perhaps 20 seconds. My friend will be able to get insurance, as the law promises, and because of her circumstances she will be able to get subsidies as well. In fact according to the site (which provides estimates only) she has options under the Bronze plan that after subsidies she will be paying just $1.00 per month.  Yes, you read that correctly $1.00 per month for the premium. But she will also have a deductible of about $2500. before she gets to coverage. Some items are exempted from the deductible so in some cases she doesn’t have to pay anything.

I have not spoken to her but I would bet that she will think this is a good deal at this point. Depending on how the actual deductible plays out in her circumstances, she may or may not find this is a good deal 6 months from now. While this is a good deal for her, is this a good deal for most? Or the better question is this a good deal for America inclusively?  And, it is here that there is a rub. While the government is simply printing money out of thin air to pay for the bills, this new money still comes out of our pocket by reducing the real value of the dollar. And as we age, we disproportionately cost rise more and more for the care we need. From birth to age 70 we cost about $100,000 for care, and from 70 to 75, we cost about $500,000 for care.  The same curve happens from birth to 50.  So at mid 50s we cost significantly more than someone who is in late 20s early 30s. As a result those later life spiraling costs get disproportionately allocated to the younger insured. And the actuarials are not static numbers. Due to many factors they continue to rise and they will rise exponentially under the current rules. This is not due to greed, corporate profits, or expensive technology, it is due to simple mathematics. As we live longer that curve of costs goes ever higher. And under the current law the costs, are neither constrained nor controllable. They simply get reallocated.

I am truly very happy that my friend is able to get coverage, but I am also very concerned that we are hiding the overall cost and stacking increasingly unsustainable burdens on these future generations. The math is clear, even if we just don’t want to see it.  We not only are placing the rising cost burden on the young whose own costs will get exponentially higher as we continue to extend their lives beyond our own,  but we will also present them with a huge moral burden as well for while this generation will not create the death panels as promulgated buy the extreme edge of the republican party, the will have to made a determination of at what age quality of life care is suspended for elderly under government programs and their parents and grandparents own savings or additional private policies pick up the costs. Otherwise the cost for them in their early lives will be increasingly unpayable and the nations economy will collapse under the cost..

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About Thomas W. Loker

Meet the Author - Thomas Loker is a Startup Consultant and Advisor at SYDK.ORG, Angel Investor, Mentor and Advisor at Keiretsu Forum & Venture-Med and an established operations guy with serial successes with startups, transitional companies and turnaround situations. He has had a long career serving in the fields of science, technology and healthcare related industries. He is an active board member in both for-profit and not-for-profit companies. Tom has written numerous articles in the areas of healthcare, technology, politics and the economy. He is currently the principal author of Health Reform 2.0: Beyond partisan divide lies pragmatic solutions – a whitepaper focused on moving beyond the partisan rhetoric of the ACA (Obamacare) to a simple, efficient, effective, accessible and affordable healthcare system. He maintains a passion for serving the underserved and has founded, supported and worked in various companies to serve the most fragile among us. Because of his expertise on the business of healthcare, he was invited to conduct multiple congressional briefings on healthcare reform in Congress, meeting with more than 100 congressional representatives. He has been a guest on HuffPost Live to talk about health care issues, and is a frequent keynote speaker on the topic for many groups and events. Prior to his latest book, The History and Evolution of Healthcare in America: The untold backstory of where we've been, where we are, and why healthcare needs more reform, Tom published “Delusional Ravings of a Lunatic Mind”—a collection of essays on healthcare, politics and their interaction with the economy, available at Amazon, Barnes and Nobles, and other bookstores. Tom's passion for Music is currently expressed by his role as VP Operations and General Manager of David Victor Presents. See www,davidvictorpresents.com to find out more. You can find Tom online at: Website: http://www.loker.com Blog: https://tloker.wordpress.com LinkedIn: http://www.linkedin.com/in/thomaswloker Photography: http://www.loker.net

One thought on “The ACA Exchange Connundrum

  1. I think I know the woman you are speaking of. She is in her mid 60s though, and yes is thrilled to be able to get coverage. The issue you left out is that without the ACA she had become uninsurable since 4 years ago, after just losing a longtime career in financial services, had a 0 stage melanoma on her shoulder. The first words from the surgeon who removed it, and knew of her job situation, were “you are now uninsurable”.

    Regarding deductible, she is fine with a high deductible, she does not run to the doctor for every little thing. But in the event of something catastrophic, with a home and some retirement savings, she would not be in danger of losing everything. This is another signature piece of the ACA. Many folks today, who are self insured, have deductibles as high as $10,000! Even families with employer sponsored insurance, have opted for very high deductibles to get the monthly premium manageable! They still pay some co pays and many things are not covered.

    The fear mongering going on is shameful. Why not try to work toward a universal health care delivery system that could be the model for other developed countries. Like we do with the military.

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