Open Forum: Time will tell . . .

Posted: December 3, 2013

Everyone is focused on the many people who are losing their insurance plans because their employers are dropping coverage. Their plans apparently do not meet the minimal standards set forth in the Affordable Care Act. And President Obama is being castigated since he stated that no one who liked his current plan would have to choose something else, and he was wrong.

But I have read that about 11 million Americans lost their employer-sponsored health coverage between 2000 and 2012, before the ACA was enacted or before it came into force. These people lost their coverage when their employers decided they could not afford to offer health insurance, with the steep rise in costs for health care we’ve seen over several decades.

So losing your employer-sponsored health coverage is nothing new for Americans. What is new is that you can now buy a plan (if you can get on the web site) that offers better coverage. The evidence for this is the thousands of Americans who have been able to purchase health insurance since October. Some of them have been able to do it through the federal web site (though far fewer than wanted to), while other thousands have been able to do it through state-sponsored web sites.

The states of Washington, Kentucky, and Connecticut, for example, have apparently opened successful web sites where people with limited budgets can buy health coverage — people who could not afford any health insurance before. Now, Virginia chose not to open its own web-based market, and so low-income Virginians who want to buy insurance must try to use the federal site. Maryland opened its own web-based market (and apparently is having some of the same technical glitches the federal site is having).

But, gradually, people are being successful at purchasing health-care plans. And it is obvious that many hundreds of thousands of Americans want to buy health insurance. They can now purchase plans even if they have preexisting medical conditions, which they often could not do prior to the ACA being enacted. And they can keep their plans even if they leave their job to take a better job with a different company, which they could not do before the ACA.

Ten years ago, if your employer dropped your health care insurance, you were on your own to replace it, and if you had a chronic health condition, you were unlikely to be able to find new coverage. Now you can find it.

Ten years ago, if you got sick and needed expensive treatment, your health insurance company could drop you from coverage if your expenses surpassed some limit determined by them. So you could be in the middle of treatment for cancer, and suddenly your insurance stopped, and you were on your own. It would be like having fire insurance that covered you if one room in your house was destroyed by fire, but if your whole house burned down, the insurance company could say, “Sorry, we don’t cover that.”

Now, with the ACA, if your medical treatment is costly, your insurance company cannot drop you. After all, you bought and paid for insurance to protect yourself from the possibility of medical bills that you could not afford to pay by yourself. With the ACA, health insurance companies must actually pay your medical bills and cannot drop you because you got too sick.

It is going to take a while to see how the ACA works out. It has been in force for less than a year so far. A lot of people are interested in getting health coverage. More than 40 million Americans are currently without health coverage. When you are poor and don’t have coverage, you either put off going to the doctor until you are very sick, or you go to the emergency room, which by law treats you for free since you have no money and then charges everyone else more to make up for the free service.

If you’re poor and have health insurance, you can go to the doctor when you get sick and get treatment that may prevent you getting sicker, and you don’t need to go to the ER as a last resort.

Many people have predicted the ACA will be a disaster for the country. Others have predicted that it will allow people to get health insurance who otherwise could not afford it, and that it will do a better job of protecting people from the high costs of serious illnesses. It will be interesting to see how it goes over the next several years.

Scott Bailey is a resident of Frederick County