Jewish Journal

What does Obamacare mean to you?

by Shmully Schwartz

January 7, 2013 | 4:39 pm

OBAMACARE!!!  It's a word that strikes fear into some, smiles onto others and confusion onto most! What is The Affordable Care Act?  Who does it affect?  Is it good?  Is it bad?  One blog isn't enough to tackle these questions, but we'll try and answer a few of them today!

Is there really a 716 billion dollar raid on Medicare to fund Obamacare? 

No, plain and simple.  Let me explain the dollars and cents of what's going on with this magic 716 billion-dollar number. Medicare Advantage plans and hospitals are paid capitations (a set monthly dollar amount per beneficiary) and bonus dollars. Obamacare has a provision in place starting 2013 that will only pay these bonus dollars if the plans and medical providers meet minimum quality standards.  That means if an Advantage plan doesn't meet minimum star ratings, and medical providers don't meet the standards in place, they won't get a bonus.  Those dollars are then spread out over ten years and that's how we answer the 716 billion dollar question.

Do all men really have maternity coverage on their health insurance?  

Yes.  Although science shows I will never be able to have a baby, I have that coverage on my health insurance.  That's whether I want it, or not...

I've heard that I can get health insurance with a pre-existing condition now, is that true?

Yes and no!  Today if you are under 19 and have a pre-existing condition, the health insurance company cannot turn you down.  If you are over 19, this starts for you in 2014.  According to healthcare.gov, "The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status."

Are my health insurance premiums going to go up?

Yes.  There's going to be no way around this.  Health insurance companies are here to make a profit.  I know this sounds counter intuitive to the quote written above, but let me explain.  Health Insurance companies aren't going to be able to charge higher rates to a select few due to gender or health status.  This means they will simply charge higher rates to all of us!  I say this as fact, because it is.   

My Doctor said that Obamacare is going to drive him out of business?  

A trend that we see coming down the road is the end of the private practice.  Medicine is moving in the direction of managed care, for better or for worse.  Let me explain.  My doctor once told me that he's the only professional that goes to school for 8 years and doesn't ask you to pay him at the time services are rendered.  That's a great point!  We know we are going to be gauged when we see a lawyer, we expect to be bamboozled by a contractor, but if a doctor asks us to pay him, we're insured, we don't need to pay him! Private practice physicians are getting increasingly lower payouts from insurance companies.  Additionally, they need to fight to get what they're promised.  Have you ever gotten an explanation of benefits from your insurance company and read it?  The insurance company screws the doctor!  Now let's look at your doctor who works for UCLA, HealthCare Partners, Kaiser or Cedars.  These guys and gals get paid a pretty great salary and most of their bonuses are based on quality measures, not quantity measures.  Don't get me wrong; if they're not seeing patients, they're out the door!  However, the trend is more and more physicians are now working with big medical groups to avoid the pitfalls of private practice.  Is Obamacare driving the private practice doctor out of business?  Maybe not, but it sure isn't helping them to stay in business either. 

I agree that something needs to be done, but is forcing everyone to get health insurance the answer?

We tend to agree with that statement.  The bigger issue is the medicine for profit system we live in today. Most people agree that healthcare should be free, but how?  At the expense of higher taxes, my pocketbook doesn't seem to like that answer!  Doctors go to Med school and drive themselves into 100k plus debt in hopes to make it big.  Medical billing is so complicated; they have 2-year programs dedicated to it.  Nurses go to school for six years and dig themselves holes similar to the doctors.  Hospitals are run for profit, for the most part, and the ones that are not-for-profit still need the money to keep the lights on and the staff paid.  Finally, there are the good old insurance companies!  If there's ever a nuclear disaster there are two things that will survive, termites and insurance companies!

Over time, we are going to address the issues that are a concern to many people both in the Jewish community and abroad related to healthcare.  All we ask is, if you like something we have to say, be a mensch and pass it along.  If not, well, go ahead and say something anyways, there's no such thing as bad press!!!

Simpler Horizons is an Insurance Brokerage firm specializing in health insurance and related lines.  If we are not your trusted advisor, speak to your trusted advisor before reacting to anything we write!

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