ObamaCare Clusterfuck: Press coverage slowly coming to understand ObamaCare's high deductibles and co-pays
One Texan Weighs Obamacare Options: High Deductible Vs. 'Huge Fear'
[Tammy Boudreaux] was hoping to find a better deal on healthcare.gov. Boudreaux has logged on, looked at the plans, and so far, remains largely unimpressed.
She likes the monthly premiums that she sees but balks at the annual deductibles.
"Let's say if I paid the $178 a month, my deductible would be $5,000," she says. "I would have to pay up to $5,000 before I received any kind of payment from my insurance company."
As a comparison, the average deductible for single coverage in employer sponsored insurance is about $1,135, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
Boudreaux could get a lower deductible if she paid a higher premium, but about $200 a month is all she feels she can afford. She doesn't qualify for subsidies to help pay for a policy, either.
"I don’t smoke, I'm relatively healthy, so I was pretty insulted when I saw this [price]," she says. "I was extremely angry actually. I felt hoodwinked by the insurance companies: 'Oh here's this wonderful insurance plan but by the way you need to come up with $6,000 out-of-pocket first before we pay for anything.'"
That is the "she said" from Boudreaux. So here comes the "she said" from the expert, Pearson:
That reaction is typical, says Caroline Pearson, an analyst and expert on the new health insurance marketplaces for the consulting firm Avalere Health.
"A lot of people aren't ever going to get out of that deductible," says Pearson. "Only if you have a catastrophic health event or you're really chronically ill will you ever hit your out-of-pocket cap. People are left, I think, feeling like 'I spent a lot of money this year on premium and I didn't get any meaningful coverage from my insurance.'"
But Pearson says people forget two things if they just focus on the high deductible. One is that the new plans must offer some free preventive services, like mammograms and yearly physicals [As Dromaius points out, those are tests, not treatment]. The other is that having a plan protects you from medical bankruptcy if you get in an accident or face something like a cancer diagnosis.
That's because Affordable Care Act requires that health plans have a yearly limit on out-of-pocket expenses. If something did happen to Boudreaux, she wouldn’t pay more than $6,350 in the year.
A statement which the journalist does not go on to question. However:
- $6,350 in the year (and subsequent years?) could surely bankrupt people at the edge (and ObamaCare will surely have a disproportionately high number of those). A person can drown in a puddle of water an inch deep, just as much a they can drown in the ocean;
- The yearly limit probably will not cover out-of-network costs or out-of-formulary pharmaceuticals, which could run into many, many thousands of dollars.
So Boudreaux is right to be skeptical, and the reporter should have questioned Pearson on her assumptions.