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Health Care Truths: The Good, the Bad, and the Ugly

Written by  // Monday, 27 January 2014 10:47 //

HealthCareDebateThe Affordable Care Act has been vilified and lionized. The healthcare law, otherwise called Obamacare, has had more snags than an old sock. The website rollout was a failure. The politics surrounding the drafting, legislating, and implementing of the bill and then the law has been an utterly unmitigated disaster.

 

We’ve heard bogus claims, from grandma being thrown under the bus to you can keep your insurance and your doctor.

So, now that roughly three million people are covered under the law, what is it?  Who does it benefit? Is Obamacare really a scare? Is the Affordable Care Act really affordable?

Growing quite tired of hearing our politicians repeat talking points and their surrogates and then regurgitate them, I wanted to get to the facts, if possible.   

Who wins and who loses? What should potential insureds consider when they shop for health insurance?

For help with some of the questions, I turned to Ronnell Nolan. Nolan is President/CEO of Health Agents of America,"HAFA", an non-profit Trade Association for health agents. HAFA lobbies, educates and protects Health Agents and the clients they represent. She is also President of the Nolan Group, a lobbying firm.

In reaching out to her, I explained that I wanted the straight and narrow. In other words, the truth, no spin.

She told me I would get it.

The first part of the conversation focused upon her experiences at the Baton Rouge capitol and her organization and then we got into the meat.

I told her of my own experience with the navigators, who I felt were well-intended and very helpful but undertrained. Some of them were unable to answer basic questions while others were apparently quite competent but surely not Insurance Agents.

Nolan explained to me that one of her biggest beefs was the fact that the navigators received more training about the changes and nuances in the law than agents.

So, for now I would agree that even though the navigators were better apprised of the law’s updates, they were generally no match to the health insurance agents.

Then, we got into the meat of the discussion. What exactly is the law, who does it benefit and is it as good or as bad as some in our political circles want us to believe?

Below is the transcription of our discussion. For the most accurate accounting, please watch the video; however, I apologize in advance for an echo surrounding my questions:

 

BAYOUBUZZ: If I wanted to get insurance I can go to an agent and i can say to the agent please help me out with my insurance needs or I can go online to healthcare.gov and I could try to get the information from the navigators from the site.  Am I correct so far?

NOLAN: Right.  absolutely.  It's important to know that the premium is the same whether you use an agent or you use a navigator or you do-it-yourself, it's always the same, you do not pay anything extra.

BAYOUBUZZ: Now are the policies the same?

NOLAN:  Absolutely.

The policies are the same.  Everything is the same

BAYOUBUZZ: So the reason I ask this is because, I went online and I saw an insurance policy that I thought would be helpful, I talked to a navigator, I talked to an insurance broker and I was very confused because the information I got online indicated that the coinsurance did not have a cap so the co-pay and you are talking about the co-pay and the coinsurance.

NOLAN:  Right

BAYOUBUZZ: Now according to the insurance policy the coinsurance did not have a cap but when I talked to the navigator they said no this is capped by law so for example, the 20%,  the 30%,  that would be coinsurance

NOLAN: Right

BAYOUBUZZ: I found that at least according to the navigator that I would not have to worry about the 20%-30% over and above the out-of-pocket costs and that's separate from the deductibles so   

NOLAN: I’m not sure what information you got. there so many different plans that you can pick from and there are parts of the law that cap the out-of-pocket, but different ones operate different ways, some of them might have a deductible, you have to satisfy your deductible and then everything is paid at 100%.  

NOLAN: Or some might have co-pay. I know that Louisiana co-op, the’re different, their co-pay goes towards your deductible so there's a lot of little nuances. Some of the Blue Cross plans actually have a $500 deductible for prescriptions in addition that people don't realize, so there's a lot of different things with each one.  

NOLAN: and then again if you are between 100 and 250% of poverty than those plans you pick a silver plan with the deductible is reduced, your coinsurance is reduced, your copayments are reduced. so it gets a little bit complicated.

BAYOUBUZZ: Yes indeed.  Sure it does but I understand what you're saying with the differences in terms of the deductible and the co-pay and the coinsurance, and deductibles going in for the out-of-pocket caps but as I appreciated it, the main difference with this law is that the law says that the insurance company cannot make the insured pay for anything over the out-of-pocket caps but the policies themselves would indicate for example like let's say you go to the hospital and have $100,000 bill what you have a cap for 6000, so as I appreciated it, anything over %6000 the insured is not to be responsible,  if the cap is 8000, then that's all you are responsible for--despite the language of the policy that says 20/80 or 30/70 for the coinsurance..

NOLAN: the way it works is you have a deductible--you satisfied that, and then depending upon the plan whether it's 80/20, 70/30 the insurance company pays the 80/70 you pay the other (20/30).  Once that total equals up to your out of pocket, as you explained at 6000 or 8000, then your plan is paid at 100% and what the law did was eliminate the annual or lifetime max so it will never max out.  But every year, your have the deductible and the out-of-pocket starts over.

BAYOUBUZZ: so assuming that is correct and that is my understanding too,  okay, and not looking at whether or not this is going to bankrupt the country or anything of that nature, but just looking at the policy, the policies as they are, and not considering privacy issues or anything like that, just the policies themselves--that sounds like a pretty good deal for the insureds.

NOLAN: Well, I'll tell you the good, the bad, and the ugly.  If you under 100% of poverty level there is no help.  So if your talking to somebody that says I make less than 11,500 and your single person you tell them that they have to go to a free clinic--and it's heartbreaking-- if you make between hundred and 400% of poverty absolutely the federal government helps you pay for the insurance premium and sometimes the deductible and co-payment; those over 400% of poverty, the rate have, are either doubled or tripled.  So this helps some people make some people, its going to make some people pay more, it just depends upon where you got, you fall into the category. So those who gets subsidies, absolutely it it helps them, but it doesn't everybody and I guess that's the law.

BAYOUBUZZ: Yea, now, you mentioned about if you're under the 100% and below, if you're in Louisiana then you have to go to these clinics or the hospital or the, whereever the emergency room might be

NOLAN: right

BAYOUBUZZ: Because the governor has not extended the Medicaid, but in other states, in other states, the government has extended the Medicaid--am I correct?

NOLAN: Well he decided not to ask expand Medicaid and I'll be honest it was very confusing during the session last year people did not understand, I honestly don't understand, even if we expand Medicaid, if it is going to help people under 100%.  My understanding is that it would help those 100 to 138% so if you're an employer plan and and were in between 100 to 130% federal poverty, you can get off your employer plan and  you can get Medicaid.  I am not sure and I actually have a meeting this afternoon with DHH to find out if it really helps those under 100 and a lot of people think that Medicaid is for the poor it is not--it is for if you're pregnant, if you’re a child  if you disabled or if you're blind, it is not for the poor and is not for the working poor,  and the law, the ACA is not for the working poor-- so we really need to figure out where the Medicaid expansion really help those under the hundred percent and if it doesn't then Louisiana needs to create their own legislation that helps that group of people that have to go to free clinics or one of the hospitals have been closed so they don't have a lot of options to get help

BAYOUBUZZ: Yea, it is my understanding that, in the research I have done, is that basically if you are 100% percent and below that you don't have any choice at all, but if there is Medicaid expansion, it would help those people would be say in that bracket but if you have any information that DHH provides I definitely like to be updated..but that's information that was provided to me, at least by advocates of the Medicaid expansion and so I am just going to go by that of this point ,until I hear otherwise.

NOLAN: it seems like to hear different things from different sides and you just want to hear the truth, the truth, just what does it really mean and I guess yet to meet somewhere in the middle.

BAYOUBUZZ: And that is what I been trying to do, and quite frankly I been trying to get an idea as to who this helps and who it doesn't help and why.  I mean.  To me, it doesn't make any sense that the state doesn't expand the Medicaid for these people unless they have a system in place that will substitute for it.

NOLAN: Right

BAYOUBUZZ: But if they don't have a system in place that would substitute, then to me it would be very injurious to the peoplewho need it the most and that's why I like to find out the system that they have in place

NOLAN:: And that's one of things I been trying to find out, because of legislators are confused.  I read an article about one of the Senators the other day who thought people between, well actually thought that people, under 138% of poverty didn't get help in the in Louisiana, and that's not true.  And so I think this so many misnomers out there, so we need to get to the facts and figure out what is going to help the people in Louisiana

BAYOUBUZZ: Definitely agree.

BAYOUBUZZ: Now as for as you saying doubling and tripling, I've done some research, I put together some hypothetical situations, my numbers might be a little off or so but for example, a person making hundred thousand dollars,  50-years old, single, a single male--a hundred thousand dollars, living in Jefferson parish, the most he would pay or she would pay would be and i am just ball parking. Roughly about 10 or $11,000, period. Okay.  A year. And that is including the deductible and the out-of-pockets and so that is what I'm trying to figure out, well, if that's what they're saying on the website, then how in the world can the policy be doubling and tripling and the out-of-pocket costs be any more than what the out-of-pocket cap Is.

NOLAN: Right, it is a little more confusing.

NOLAN:  Yea, it's a little bit more confusing than that is definitely based on ZIP Code,  that is important, no more  male or female,  that the rating ratio used to be like 1 to 11 now it's 1 to 3.  So if a young person is charged hundred the most than older person be charged is  300.  So those younger people are going to have huge rate increases, older people or sick people who might be getting rate increases because of their illness there's might actually come down.  It would make them come more to the middle.  But you really can't say one person is going to the effect one way.  It's just that group of people based upon their age.  So the 50 and over might actually turn out pretty good for once

BAYOUBUZZ: Or somebody with a pre-existing condition

NOLAN: exactly

BAYOUBUZZ: Who couldn't get insurance for that pre-existing condition or maybe couldn't get insurance at all or had insurance and got kicked off or found out that wasn't covered because the insurance company, you know, as we know has a way of trying to stop their own hemorrhage.

NOLAN: Right.  That is one of the reasons why recissions were included in the bill, that insurance companies couldn't find out that you did didn't tell, you know, about a toenail fungus and cancel because you have leukemia.   Louisiana already had law so we didn't do that here but across the nation they did do things like that and that was a protection for people who had something really wrong with them.  They had a cancer and the insurance company couldn't go and rescind that policy--unless it was because of fraud.

BAYOUBUZZ: Okay, uh.  That is new to me, I must tell you, so like prior to the law, if I want to get insurance and I had a condition and I disclosed that condition--as I understood it, the agent would say, "I'm sorry but you have to wait a year or two years whatever it may be', and i think it's two years before they'll cover that condition--Assuming you don't have any occurrences, paid occurrences, for that condition.

NOLAN: Companies work different, and each state, of course, their state regulations is different, but some insurance companies wouldn't take them at all.  And some might have a rider that says we'll cover after two years..but some states there were passing that somebody didn't disclose it and if it was something minor, or that they didn't think about it, and the insurance company found it and would use that as a way to cancel the coverage.   But like I said, Louisiana already had laws, but this aspect of the ACA stopped it from any state doing it.

BAYOUBUZZ: Ok.  Now so, the ACA  stands, some people are benefiting and some people are not going to be benefiting the deductibles, in terms of what their deductibles or the premiums.

NOLAN: Right

BAYOUBUZZ: Some of the premiums are going to be higher than in the past and for other people premiums will be either the same or lower

NOLAN: Right

BAYOUBUZZ: The out-of-pocket caps, however is a tremendous benefit, for the insureds..not so great for the insurance company and maybe not so great for the taxpayers of the United States.  Is that a fair statement?

NOLAN: Well, I definitely think that having caps is helping the person purchasing insurance, because, that means that they have to pay less out of their pockets.  So definitely helps them.  But you're right, the trickle down as to who it actually affects, taxpayers you know, that be coming into play but if you just talking about an individual... absolutely...If I'm buying insurance having a cap on my out-of-pocket definitely helps especially if I get some severe illness and be put to hospital whatever.  Whatever the worst case scenario is.  

BAYOUBUZZ: Yea, like a couple years goes,  for example, had a kidney stone and a bill all total was something like 80 or $90,000 and I'm going, my God, a kidney stone cause 80 to $90,000--so if that were to happen to me or somebody else,  now that would be a cap, there would be a cap I would not have to pay to that 20 or 30%.  I would just pay the 20 or 30% up to that cap.

NOLAN: Right, and really out of pockets have been in play--forever.  I mean, they have always been apart. But, this just makes sure that they're not any that are extravagant and really high.  So all the plans sold have to meet the rules of the ACA.  

BAYOUBUZZ: Yea, that's very interesting and certainly appreciate it

TOMORROW PART 2 OF THE INTERVIEW

 

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