If you are anything like me, your Facebook page, twitter feed and everyone you meet have some opinion on the Supreme Court’s decision on the Affordable Care Act, otherwise known as ObamaCare. And it is either the best plan ever or the worst decision and Justice Roberts is a traitor to his country, and blah, blah, blah. Well that was Thursday.
Friday, it was well if we don’t overturn this mess, I am moving to Canada, Australia, Costa Rica, or other English speaking, industrialized nations all with some form of Universal Healthcare or Socialized medicine. Also countries with a tougher immigration policy than we have, so I am not sure that unless you are super wealthy that is actually an option.
And then there is the stand by the Republican governors to not enact an exchange because they will fight this to the bitter end. You all know that the exchange was originally a republican idea don’t you? And probably my favorite part of the bill. Why? Well because I own a small business, I have 8 employees, when I started I had two employees, my husband and I, which accounted for a pool of 4 people. Why does that matter, because when I went to purchase insurance in 2005, I was 7 months pregnant, covered under a policy which I COBRAed through the hospital that I did my residency in. At $750 a month. Now I was just out of residency and started my practice on my own, and well $150,000 in debt from medical school, with a new baby on the way. So I looked for something, and the best I could find that would cover that baby was $1500 a month. They could not deny me pregnancy coverage as pre-existing at the time, because I live in a states that if I had insurance that previously covered a condition within the last 6 months, there was no pre-existing condition. However, do NOT ever shop for insurance when 7 months pregnant.
I called 4 insurance agents, and several companies on my own, the best that I could do was to COBRA my current policy ($750 a month) until the baby was born and then start the following month with the new insurance. Though I actually COBRA for one additional month, because there was some question as to coverage of the brand new baby. Anyway, this policy I could afford was roughly $400 a month per person in pool, oh and it didn’t cover pregnancy. And I had an employee who would like to have a baby, so we changed our pool to three, and I covered her on an individual policy, that would cover pregnancy a year after it started. (Which didn’t work because as it happens, she stopped trying to get pregnant and she had a baby 11 months after the policy started, and ended up on Medicaid for the pregnancy anyway)
Now being as I had insurance for all but my 3rd year of medical school (I had gotten married and could not stay on the plan, and well we couldn’t afford it until my husband started his internship year and it was covered) I could not believe the difference in rates. I saw what had been taken out of my check at the hospital while I was employed, and it was not that much. I talked to others as to what they paid working for bigger companies, and the talked the agent, and what the answer was the size of the pool. My pool was three, and one was diabetic, I was a bigger risk, than those with thousands of employees, who could afford better coverage for less. But if I got to 5 in the pool, or 10 the rates drop significantly, and then if I have 50 employees, well that is an even better drop.
But with an insurance exchange, here is the deal. Let’s say your exchange becomes the state for instance. Larger states might decide to have multiple pools, or smaller states might decide to join into a regional pool, doesn’t matter. The pool becomes big enough that smaller businesses or the individual could choose a plan that actually works for them within their budget. If you want to cover pregnancy care, great, here is the plan for you. I don’t cover it for my employees because it would increase my costs $200 a month per employee, and that includes the two males, who if they become pregnant, I think I would sell their story, me who has had a tubal, and another employee or two that are menopausal. There was only two of my current employees that would even desire pregnancy, and well at $1600 a month, well it is not even affordable for me to do so. And as it stood before, they could not even add the coverage as an option because my pool is too small.
While I would have preferred for the market to develop something like an insurance exchange on its own, it is highly unlikely under today’s highly politicized system, it ever would have. An insurance exchange would allow for those healthier to choose coverage to benefit them better, would allow for people to choose coverage for preventative care. At least it would ideally, but it would also allow for those with diabetes and other chronic conditions to find a plan that would cover them. I didn’t say that they all had to cost the same in my world, but prior to ObamaCare finding a plan with a pre-existing condition was impossible without high deductibles, and being astronomically expensive. And then there was a year of paying for the plan before it would cover any pre-existing condition, so you can understand the frustration for those that tried, and for those that decided against buying insurance.
Like I said, I look at it from a small business who while not required thought that it was right to cover my employees. I am in healthcare after all. I actually like this part of the ACA, there is much of the plan that I don’t. But the opposition to this part, is something that does not make sense, yes the free market should have produced it, but it didn’t. But this is a natural progression of medicine since the development of Medicare and Medicaid, a natural progression from EMTALA. I find myself frustrated at both sides on this issue, the surprise that the bill stood, the gloating that this bill is the best thing ever (it is not). In the last 6 months it was obvious it was going to stand, and if not most of the major components were going to be put in a new bill. Besides an estimated 60% of the costs in the infrastructure to support the system had already been put into place. Repealing it would have been of little use.
That is just my two cents worth. But what do I know, I merely own a small business and see patients everyday. Do I agree with the plan in whole, no. But I don’t see the alternative offered by the other side as much different.