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Guest Commentary: Obama Care - how does it work?


Fri, Nov 29th, 2013
Posted in All Commentary

By Dale J. Eppen

How Obama Care Is Supposed To Work

Obama Care uses what are called EXCHANGES that we can go through to buy health insurance. No one buys insurance from the exchange. In Minnesota we elected to set up our own state exchange. We call it MNsure. When you go through MNsure to purchase health insurance, you put the information required into their website. Then MNsure will determine whether you get a tax credit to help pay for your health insurance. Otherwise, you will be placed on Medical Assistance (MA) or Minnesota Care (Minnesota’s plan for low income people who do not qualify for MA.

The chart below will show you where you end up. Everything is based on your income’s percent of the poverty level. If your income for size of household is below 133 percent of the poverty level, you will be placed on MA. If it is between 133 percent and 200 percent, you will be placed on Minnesota Care (MC). If your income is between 200 percent and 400 percent, you will be getting tax credits to lower the health premium you pay. However, if you have minor children, and your income is between 200 percent and 275 percent of the poverty level, your children will be placed on MA, and you and your spouse will be directed to purchase an insurance plan. If your income is above 400 percent of the poverty level, you would be better off purchasing your health insurance outside of MNsure.

Once you are approved by MNsure, you qualify to apply for an insurance plan, and you will know what your tax credits will be, and then you will be able to choose an insurance plan. In southeastern Minnesota we have the choice of one plan with BlueCross BlueShield of Minnesota or six plans with Medica. The companies have different hospitals and doctors they are contracted with, called “networks.” When choosing a plan, you need to know where your doctor and where you would go in an emergency.

In order to be truly enrolled for January 1, 2014, your premium must be paid by December 15, 2013.

MNsure is only for those who are not on Medicare and its enrollment can be done the easiest and the quickest on the internet.

How Obama Care Really Works

First off the website is down well over half the time! My experience, so far, would say . . . three quarters of the time. Sad to say people are being put on MA whether they like it or not. People are being placed on MA and MC regardless of their net worth. Those individuals who are not qualifying for tax credits are having their premiums go up on average 50 percent to 60 percent.

Nationally, as of the end of October, about 106,000 people applied to the exchange, of which about 30,000 people were from Minnesota. As of the 20th of November, only about 1,800 have been approved. It takes about two weeks for MNsure to approve an application. Just this week the process of sending approved applications to the insurance companies is being tested. How long will it take to get this system working? When will the premium notices be sent out from MNsure? Will they be sent out with enough time to get the premium paid by December 15? There are too many unknowns to say it will happen.

We in southeastern Minnesota are paying substantially higher premium than the rest of Minnesota. The reason we are being told is that the Mayo Clinic is the highest priced medical facility in the state. This is why we have paid higher premiums for a number of years than the rest of the state. The real question is why are they gouging us this bad? Our illustrious congressman Tim Walz’s office says this issue needs to be investigated. They offer numerous excuses for the mess occurring now, but haven’t offered any real solution. Walz’s office keeps saying to wait and it will eventually work its self out and those opposed to Obama Care have caused the problems. I did not think they hired saboteurs to implement the program.

Problems As I See Them

The process to enroll is a disaster. The government thinks everyone understands health insurance and can do this on his/her own. The government is enlisting navigators who are given some training, and they are expected to know the ins and outs of health insurance with no experience. The government also expects people to do this application process on their own.

I have sold health insurance for over 37 years. I have a number of insurance agents either calling me with questions or referring people to me because of complex circumstances. These are agents that have sold insurance for a number of years themselves. So how can someone just step in and explain this complex process to you?

Will they tell you that a blood test is not preventative when your cholesterol level is borderline? Or, will they tell you that your colonoscopy is no longer preventative if they find or if you have ever had polyps? These and other things you only learn by experience. Can they explain networks or how they apply or don’t in an emergency? You only learn these and other things by experience. Can they explain how “networks” apply when visiting a doctor or in an emergency?

Cost containment . . . . there is none in Obama Care. The issue of lowering cost is not even addressed. In fact, durable medical equipment (hospital beds, wheel chairs, oxygen, etc.) is taxed to help pay for the plan. If you are taxing what you are paying for, this drives up the cost. This is just as a sales tax increases the cost of items you buy.

The argument that Obama Care will get more people insured and thereby curtail excess ambulance runs and emergency room visits, holds no water. The only way to end this kind of abuse of the system is to make the doctor visit cheaper than an ambulance run to the emergency room. Has anyone thought of all people paying say, “A $25 copay for an ambulance run and another $25 copay for an emergency room visit?” This includes people on medical insurance, MA, MC, and Medicare. Finding an alternate means to get to a clinic and see a doctor, not the emergency room, will lower the cost.

There are two ways to cancel insurance policies. One is for the insurance company to terminate your policy and the other is to raise the premium to the point where it becomes unaffordable. I have some clients whose premium wills more than double on January 1, 2014. Mine personally went up 70 percent. When do we drop our health insurance because we cannot afford it?

The goal of Obama Care was to insure 30 million more people. Now the government is saying that it will be a success if 500,000 enroll. Have we the people been sold a bill of goods?

On the plus side I do think everyone should be able to get affordable health insurance. We in Minnesota had a plan available through the state pool. It was called Minnesota Comprehensive Health Association (MCHA). We in Minnesota have had loss ratios on health insurance companies for years. Obama Care doesn’t help us in these areas at all.

I am a 63 year-old male, and I was happy with my coverage before, so how has it changed? My premium went from $350 per month to $617 per month. What changed? My deductible went from $6,000 to $5,200, I now have mental and nervous disorder coverage, I also have drug and alcohol coverage, and I have maternity coverage, also! Why would I spend $267 per month more to add these coverages? Would someone please justify this to me, and the rest of us in Southeastern Minnesota? Why am I am being forced to do this?

Did something need to be done with the system we had before? Yes it was broke. Obama Care was not done by a national debate in order to find the best plan for the country.

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