Injecting More Pain into Our Health Bills

Whatever happened to 'affordable'?

When Richard Rivera, 32, a freight broker from the Atlanta area, had his first child in 2013, his family paid $150 in out-of-pocket costs for the birth. His employer’s health plan paid for the rest.

Just three years later, Rivera is expecting his second child. This time, he’s been told the costs will be $1,900. And this time, his family is on insurance from the state marketplace.

“The costs are so different,” Rivera told LifeZette. “That’s not a small increase.”

He said the disparity in costs — and frustration over having to pay more for insurance premiums and doctor visits — is a “constant conversation” in his household.

Rivera, who runs a photography business on the side called This Original Life, said he is making more money than he was three years ago, but he’s still frustrated by the price surge.

“That still doesn’t equate,” said Rivera.

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“We’ve been told it will cost just over $1,900, and that is if we have a perfect birth, with no hiccups, which is unlikely because my wife had pre-eclampsia the first time around,” Rivera added.

Stories like his are common today for Americans insured in and out of the Affordable Care Act (ACA) marketplaces.

A new Kaiser Family Foundation report found that people covered by their employers’ health plans saw their out-of-pocket costs grow by 77 percent from 2004 to 2014. The increases now exceed the health plans’ average payment per enrollee.

“This is not an equitable way to provide care. It’s more of the same, and it’s not the solution.”

Between 2006 and 2015, the average deductible for people with employer-provided health coverage rose from $303 to $1,077, the report said.

From 2004 to 2014, the average payments enrollees put towards deductibles went up 256 percent, from $99 to $353. Coinsurance payments went up 107 percent from $117 to $242 and copayments decreased 26 percent from $206 to $152.

The amount patients paid in shared costs went up 77 percent — from an average of $422 in 2004 to $747 in 2014.

On average, insurers used to cover 86.7 percent of medical expenses. That went down to 85.3 percent in 2014.

Controlling Costs
People covered under the ACA have limits placed on out-of-pocket costs — but that is yet another cost on the rise.

In 2015, the limit for out-of-pocket costs was $6,600 for an individual plan and $13,200 for a family plan. That rose this year to $6,850 for an individual plan and $13,700 for a family plan. This is, of course, after a deductible has been met.

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“These limits can be enormous if you look at the actual plans,” Dr. Robert Zarr, a pediatrician in Washington, D.C., told LifeZette. “When people have a deductible of several thousands of dollars, can you imagine all they have to pay before the insurance works?”

Zarr said more people have insurance with the ACA, but that doesn’t mean the coverage is good. He said most people cannot afford the best coverage available through the marketplaces.

“This is not an equitable way to provide care. It’s more of the same, and it’s not the solution,” he said. “We need to stop going down the same path, which is depending on the wide variance of insurance provided by fewer and fewer for-profit insurance companies.”

“We have more people with insurance but the insurance they have is faulty. It’s not the kind of insurance they need,” said Zarr, who also serves as president of the Physicians for a National Health Program, which supports The Expanded & Improved Medicare For All Act (H.R. 676).

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He said the consumers — especially young adults — are taking notice of how the health care system is passing more costs onto consumers. He noted that this has been happening for several decades, not just since ACA approval.

“People do understand, they do get it,” he said. “And times are bleak for a lot of people.”

Taking Charge
John Marshall, a spokesperson for the Signature Medical Group, told LifeZette that all Americans — patients, doctors and providers — need to better understand how the system works and how the money flows.

“That way, we all can drive a movement toward more affordable, quality health care,” said Marshall.His organization, Signature Medical Group, is a network of physicians not employed by a hospital in an effort to keep costs lower for patients.

Dr. Jonathan Kaplan, a plastic surgeon in San Francisco, said consumers need to shop around for services. He believes the ACA has shifted higher costs onto others because of the number of new enrollees.

“For some reason, no one expected it to cost all of us more money — maybe we’re surprised because the plan was called the ‘Affordable’ Care Act.”

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