In late March, I received a letter notifying me that United Healthcare had discontinued my existing Oxford health-insurance policy, whose contract year was set to end on August 31. Because of the Affordable Care Act – commonly known as Obamacare – I would have to choose from new Oxford products or other legally compliant plans offered on New York State’s health-insurance exchange. The A.C.A. made sole-proprietor and small-group policies for businesses owned by a married couple effectively obsolete.
Tempted as you might be to take this as yet another horror story of healthcare reform, please read on first.
No fan of Obamacare, my health-insurance broker advised me to keep my Oxford policy as long as possible and switch to an exchange plan at the end of the summer. (The termination of my current policy before the calendar year was over is a so-called qualifying event, permitting me to enroll outside of the customary period.) But I decided to register on the New York State of Health website right away and start researching what was on offer, aware of the imminent March 31 cutoff to sign up. Here is some of what I learned about the Health Republic New York EssentialCare Platinum Plan:
The monthly premium for me is $515.81 in 2014, compared to $520.64 (through August 31) for my Oxford Exclusive Metro Plan/Liberty Network, both of which are restricted to in-network providers;
The deductible is zero and the maximum of out-of-pocket expenses is $2,000, versus a $2,000 deductible and a $3,000 cap on out-of-pocket costs under the Oxford policy;
The copayments to visit a primary-care physician and a specialist are $15 and $35, respectively, compared to $25 and $50 for the Oxford plan;
The copay for a three-month supply of my costliest asthma medication – Advair Diskus (100/50) – is $90, and I could get it filled at the neighborhood Walgreens, versus the $275.55 I last paid OptumRx, United Healthcare’s captive pharmacy-benefit manager, to have it dispensed through the mail.
By the time I had contacted my most important doctors, and found that all of them accepted Health Republic insurance, it was early April and well past the enrollment deadline. I wanted to wring my broker’s neck for not advising me to switch at the earliest opportunity. But a fortuitous email from New York State of Health soon appeared in my inbox, alerting me that because I had begun my registration before March 31 I was entitled to select a policy on the exchange by as late as April 15. Without delay, I terminated the Oxford plan and joined Health Republic, effective May 1.
It is premature to review the new platinum policy, although my limited experience with it (several interactions with customer service and one prescription filled) has been satisfactory. But, on paper, the benefits of Obamacare to those like me who have lost sleep from health-insurance insecurity are great. I realize that some people have been inconvenienced and even disadvantaged by the A.C.A., yet strongly believe they are far outnumbered by those of us who have gained. To the disgruntled I say: try being a little more charitable. I do not begrudge the beneficiaries of Medicare because my late wife paid into the program throughout her career only to receive nothing back. But I do resent the Republican/conservative “messaging” to the effect that people who had trouble getting health insurance under the old regime somehow did not deserve it. And if the doomsayers are correct about Obamacare, why hasn’t it wreaked havoc in Massachusetts, which adopted a similar (indeed, seminal) program years ago?
Most of all, I salute President Obama, who evidently cared enough to spend precious political capital and stake his legacy on reforming a deeply unfair and dysfunctional healthcare system. The A.C.A. may be far from perfect, but for tens of millions of Americans it is a vast improvement over what we had to endure before.
Hooray for Obamacare!
Our son Charlie’s plan through Washington State’s “Healthplanfinder” — he got something called the Blue Cross Premera Gold Plan with a $1,000 deductible for $325 a month. He previously had the California Anthem Blue Cross PPO with a $1,500 deductible for $485 a month.
(Our son Nick was covered until age 26 under our plan. But before Obamacare Charlie had to buy into a very expensive COBRA Plan.)
I think this is the best thing that Obama has done with his presidency. It’ll be like unemployment insurance and Social Security, something that the people will never give up.
Two thumbs way up!
Elizabeth: People like me have had their plans cancelled — and got better ones on the exchanges! I doubt that we are the exception. Note, however, that rates in Washington and California could differ significantly.
We ended up using a “navigator” to manage the website. I will never know if my problem was operator error or the program is less than user-friendly. But my wife and I now are enrolled on medical plans costing less than we had been paying prior to the A.C.A.
As far as we can tell, none of our doctors is on the new plan. And it is a closed panel, so we do not get reimbursed if we go out of network. We might find that once we actually attempt to use the plan, some will turn out to be participants. But 50% of our doctors did not participate in our old, more-costly plan either. However, the insurance will give some assurance that should we be be visited by calamity, we will have options to avoid financial ruin.
Hank: It sounds like many of your doctors are throwbacks to the era when you could barter chickens and goats for medical care if you couldn’t pay cash. Seriously, I was surprised to find that some of the New York exchange plans — like some Blue Cross/Blue Shield plans — were not accepted by most of my providers. But I expect those situations to change over time, as this market grows. There were doctors who didn’t take my old Oxford Liberty plan either, for a while. When I researched the different offerings I found that Health Republic, among others, uses the Magnacare network, which is quite pervasive.
There is an unfortunate tendency among its critics to blame everything from restricted networks to rising premiums on Obamacare. (Some of them would blame it for global warming too, except they probably don’t believe in climate change.) In reality, the market was moving in the direction of narrower networks before the A.C.A. — and when was the last time health-insurance premiums didn’t go up? Express Scripts forced their members into a restricted retail-pharmacy network not long ago because of a commercial dispute with Walgreens. I learned a lot of this stuff by following the healthcare sector as an analyst and from shopping for health insurance for my little firm.
Gary, I honestly can’t imagine the stress that would come with even having to look around for health coverage — and much prefer our single-payer system, while recognizing its many flaws. (You never really know what you might need when it comes to your health; having to figure out what you can afford and what is worth “risking” seems really scary to me.)
It’s good to see you actually break down the numbers. So much of the conservative narrative has been all about how people couldn’t keep their existing plans (without any discussion of what they could replace them with), not to mention all those who simply had no insurance at all.
I did understand you were one of those whose coverage was cancelled, but I also know that a lot of the focus has been on the mere fact of cancellation without really considering what is available as a replacement (which is why I liked your piece).
Cara: Considering how the right has turned the A.C.A. — a conservative concept in its origins — into a political white whale, any administration in Washington that proposed a single-payer system would be risking another civil war here. Canadian society and politics are very different.
All healthcare systems are inadequate by definition because when it comes to life and death, demand is unlimited and resources (supply) are finite. Sorry if I sound too much like an economist, but the problem I have with socialized medicine is that it breeds the kind of mediocrity that Americans dislike; in this country, people have a relatively high tolerance for inequality if it sustains excellence. But the failure of the Republican/conservative protest against Obamacare is that, without a credible alternative, it’s essentially an endorsement for an unacceptable status quo. The right should get behind the new program and try to make it work better; it’s probably the best deal they’re going to get.
I agree with you, Gary, although I’m not very familiar with the insurance system used in the States for medical care so it’s a little technical for me. I get the point, though, and Americans should appreciate it in its entirety.
I think Obama has attempted and achieved a great beginning. It took such courage to do what he did.
While the A.C.A. has raised my rates considerably, it also improved my plan’s benefits. I haven’t done a cost-benefit analysis to see whether I received enough to compensate for the increase.
On the other hand, I’m willing to pay more if it means that people who couldn’t afford insurance before, now can. In the end that means that some lives will have been saved — a societal value that’s hard to quantify but is surely important.
What steams me are the ignorant on the right who call it socialized healthcare. It is not only not socialized healthcare, it is not even socialized health insurance. It is only a collection of regulations that improve the offerings of health-insurance companies, web sites that allow comparison between plans, encouraging competition, and tax penalties for non-compliance.
We’ve had occasion to watch healthcare in process in 2014 here in Tampa, as my wife broke her hip, had it repaired, then six months later had a hip replacement. Excellent care, excellent surgeon (more so the second time, when it wasn’t an emergency) and excellent recovery. The healthcare system has not only survived, it’s thrived.
Your benevolence is refreshing, Larry, after hearing so much complaining — often without justification — about how Obamacare hurt them without any mention of those who benefited.
It has become such a “white whale” on the right that even people who are better off with the A.C.A. still oppose it on partisan grounds. This is especially ironic because its concept originated as a conservative alternative to socialized medicine, giving the private insurers entrenched status in our healthcare system.
Let’s not mince words. There are many on the right that oppose Obamacare not because they dislike what it does but merely because they want nothing that comes from a black president. It’s racial hatred; no other explanation covers it.
Well, I have no doubt there are those among the masses who would oppose anything President Obama says or does because he’s black and/or because he’s a Democrat. And in the leadership class, there are those who cynically use that prejudice for political gain. But there are also those who, on an ideological level, believe that healthcare is a privilege rather than entitlement; “If you want it,” they would say, “go out and find a job!”
What’s most bizarre is that Obamacare — which originated as a conservative alternative (because it’s based on competition between non-government health-insurance organizations) to socialized medicine — has become such a “white whale” on the right.
It seems that every Republican presidential candidate has sworn to repeal it, having no clue of how to replace it without depriving millions of Americans of their healthcare coverage. Now that the national uninsured rate is at hitherto unseen levels, the political consequences of outright repeal make it hard to fathom.
Gary, when this Congress and administration manage to pass any new tax laws, or threaten to, it would be great if you could write about that from your area of expertise.
I’ve always been provident for my future, stuffing my 401(k) to the max. As I near retirement, I’m starting to worry that the administration will lower taxes for corporations and the very rich, but simultaneously seize a chunk of middle-class money by making 401(k) savings taxable.
Am I a paranoid old man? OK, probably. But am I also wrong?
Sorry about the late reply, Larry.
I wouldn’t be terribly worried about that particular development. Even the Trump budget — which looks like voodoo economics on steroids and has a snowball’s chance in hell of getting passed — didn’t touch Social Security and Medicare. It’s no coincidence that policies harmful to older Americans, who are “whiter” than the general population, remain toxic in the G.O.P.
Although many Republicans don’t seem to mind hurting middle-class Americans up to the age of 65 when it comes to health insurance, that’s easily explained by their obsession with repealing Obamacare.
You realize, of course, that most retirement investment vehicles such as 401(k) plans and IRAs appreciate on a non-taxable basis but are taxable (Roth IRAs being an exception here) upon distribution during retirement. But even if Paul Ryan and his gang of right-wing ideologues were unhinged enough to propose taxing them prior to distribution, folks like you would probably be protected by legal grandfathering. (If you recall, their abortive plan to “voucherize” Medicare had a cutoff date that protected older citizens/voters.)
My concern is that their budgetary legislation, rather than directly shafting the middle class, will finance huge tax cuts to the wealthy with massive deficits (not to mention reduced assistance to the neediest.) Our government would be in a severely compromised position to rescue us come the next financial crisis and/or economic downturn. Everybody would suffer.