Most people following the dysfunction and rhetoric coming out of DC know that the ACA (aka Obama Care) was never a perfect plan. This was acknowledged by experts, healthcare professionals, President Obama and the legislative leaders who crafted the law and passed it in 2010. The ACA is the vehicle developed to help our country address the growing number of uninsured in our country, the escalating costs of associated with healthcare costs and the challenges the healthcare system has in providing safe, quality, effective care.
Today, with health care costs reaching 3 trillion dollars, the security and economic future of the US is at risk.
All know that our country cannot continue to handle escalating health care costs and pay for the other necessary services we need to live safely. We all know something has to be done – yet our legislative leaders will not put aside their political ideologies to address the problem in a way that is palpable to all stakeholders.
I think it is important to remember that the ACA put over 20 million people who did not have health care insurance for one reason on another onto the health insurance rolls. This was a huge lift to providers of healthcare organizations who are in place to care for the population. It was also a huge lift to insurance companies as they now had 20 million new subscribers paying premiums for the privilege of having insurance.
Despite these wins, we hear the ACA is imploding. Premiums are rising, and many insurance companies have or are planning to pull out of the market. Why? The answer is complicated. One explanation is RISK. Insurance companies do not like risk as it brings uncertainty to the market. With uncertainty there is instability and instability causes companies to find ways to cover their ‘expected’ losses. To minimize risks, insurance companies are raising premiums on everyone and pulling out of markets that they view as unstable.
Another reason suggested for the failure of the ACA is that young people, healthy people, did not sign up as expected to offset the costs of those who did sign up but were sick. To help address this, the ACA put in a mandate that if someone did not obtain health care insurance, he or she would have to pay the penalty. Unfortunately, many people chose to take the penalty as they did not want ‘to be told’ they had to buy insurance, by the Government. As a result, the numbers of ‘healthy’ people in the pool was lower causing the system to be unbalanced. As a result, this led to uncertainty and caused the insurance to ‘lose’ money. As a result, insurers are raising rates and in many cases, pulled out of the market.
The other issue that has caused contentions about the Affordable Care Act is that there were incentives put in for people who made too much money to qualify for Medicaid but did not earn enough money to pay for an individual policy or an employee-sponsored policy.
In my opinion, we as a country have come to terms with the fact that to have access to health care services; you have to have health care insurance. As we know nothing is free. As a country, we need to educate everyone that it is a personal responsibility to have health care insurance as one never knows when and accident, an injury or a serious medical condition will occur. I also am of the belief that if people cannot afford to buy their own policy, the government can help.
No one knows what the future will bring. However, from history we are aware that life can change on a dime
, causing us to need healthcare services. Without healthcare insurance, sustaining an injury or being diagnosed with a serious illness becomes a financial burden that not many of us can handle.
If you have followed Nurse Advocate, you know that up until November 23, 2014, I was healthy. I pondered this question many times: “why do I need to have health insurance when I am healthy”? I took care of myself by having my preventative services done, and that is the extent of when I used the healthcare system, so why should I pay for a policy?
For me, everything changed on November 24, 2014, when I was diagnosed with a Central Nervous System Brain Tumor. Having health insurance from my employer-sponsored health plan allowed me to go to a top rated cancer center, be evaluated and treated by an expert team of professionals who saved my life. Even as a cancer survivor, I still have care needs that are costly. Today, I am on COBRA as I am unable to go back to work. The cost of COBRA is sobering; $1100.00 a month. Having this policy allows me to get the check-ups I need to have to be alerted if there is a reoccurrence allowing my doctor will find a problem early. Today, my husband and I pay our premium as not having an insurance plan would be financially devastating. I now realize the value of having health care insurance is not a choice, but my responsibility. It enables me to have access to the services and keep the doctors who saved my life.
As a nurse, a case manager and nurse advocate leader, I realize that not everyone can afford to pay this type of premium. For those who cannot afford to pay their health insurance premium, they have few choices; one being to go without care or pay privately. We all know realistically that not many people can afford to pay for health care services personally – so they go to the ED where they cannot be turned away. These people also wait till they are very sick and have to go somewhere. Most times, they are admitted to the hospital, to treat the complications and to see the specialists they need. As a result, they build up debt, lose their life’s savings and are forced to claim bankruptcy
. The hospitals and providers who care for people without insurance also lose. In most cases, the costs of caring for the un and underinsured are passed onto those who do have insurance causing the cycle to continue.
As I wind Part One up, I hope you can see that having health insurance is a necessity. When one person becomes sick, the illness or injury does not just impact that person but also affects their family, the organizations they visit and the providers who care for them. So maybe having healthcare insurance is not a right. However, it is a responsibility that each of us has to come to accept. Having healthcare insurance gives you access to the healthcare industry to get the care and services needed.
To have a stable, healthy health care system, three things are necessary: Access, Cost, and Quality
. When one is not stable, the system cannot stand. I do not claim to have the answers for how to fix our health care system. However, I do believe that we as a country can and should come together to work on the problem as it is not going away.
Next week, I will look into the area of quality and what is happening in the system to ensure our health care system delivers safe, quality healthcare to all who use the system and the role we each play.
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