[Ed. note: Although I try and avoid political entries on this blog, the topic of this blog has been so politicized, that I am not able to avoid it.]
In spite of the fact that representatives in Congress have tried to repeal the Health Care Reform Act a whopping 40 times, open enrollment is due to begin on October 1 and the Health Care Reform Act, aka Obama Care, officially will go into effect the first of January 2014. That is the good news.
The news that really chagrins me is that each time the obstructionists in Congress tried to repeal the law (which would actually benefit most American citizens) they did so to the tune of 1.5 MILLION dollars. EACH time! SIXTY MILLION DOLLARS of OUR tax dollars ended up being spent for what I can only conclude is shenanigans on the part of the obstructionists. These are the same people who keep telling us that the government does not have enough money to operate. They are the same people who can get the very best healthcare available at a 72-75% discount.* As we have been the only developed nation in the world that still does not provide universal healthcare to its citizens, the actions of these obstructionists has been destructive. Okay. Politics over. Back to the good news.
Starting October 1, people will be able to choose their healthcare coverage and healthcare provider. Health insurers are no longer allowed to deny individuals with pre-existing conditions. They are no longer allowed to drop individuals if they cost them too much or put a lifetime limit on benefits.
The following is the coverage that every citizen will have a right to regardless of the healthcare plan they choose.
Free annual check ups; Emergency services; Hospitalizations; Laboratory services; Maternity care; Mental health and substance abuse treatment; Outpatient, or ambulatory care; Pediatric care; Prescription drugs; Preventive care; Rehabilitative services; Vision and dental care for children.
Open enrollment will allow one to compare coverage options before enrolling. In this new requirement that all citizens own health insurance, the government is offering an exchange rate between what the premiums cost and what the insured will have to pay. This exchange rate will be determined by the individual states.
In Virginia for example:
The average premium, without tax credits, would be $237 a month for the lowest-cost bronze plan and $335 a month for the second-lowest silver plan.
For a family of four making $50,000, a mid-range plan, after tax credits, would be $282 a month under the second-lowest silver plan. Without a tax credit, $799.
For a 27-year-old person earning $25,000 a year, the premium would be $80 a month, with a tax credit, for the bronze plan and $145 for the silver plan, also with a tax credit.
Six out of 10 Virginians who are uninsured will be able to find coverage for less than $100 a month when tax credits and Medicaid coverage are included.
© Yvonne Behrens, M.Ed 2013
*According to the Congressional Research Service, the FEHBP offers about 300 different private health care plans, including five government-wide, fee-for-service plans and many regional health maintenance organization (HMO) plans, plus high-deductible, tax-advantaged plans. All plans cover hospital, surgical and physician services, and mental health services, prescription drugs and “catastrophic” coverage against very large medical expenses. There are no waiting periods for coverage when new employees are hired, and there are no exclusions for preexisting conditions. The FEHBP negotiates contracts annually with all insurance companies who wish to participate. There is plenty of competition for the business; FEHBP is the largest employer-sponsored health plan in the U.S.
Like other large employers, the government pays a large share of the cost of coverage. On average, the government pays 72 percent of the premiums for its workers, up to a maximum of 75 percent depending on the policy chosen. For example, the popular Blue Cross and Blue Shield standard fee-for-service family plan carries a total premium of $1,327.80 per month, of which the beneficiary pays $430.04. Washington, D.C.-based employees who prefer an HMO option might choose the Kaiser standard family plan. It carries a total premium of $825.15 per month, of which the employee pays only $206.29. (Factcheck.org)