The ‘Protection’ in the Patient Protection and Affordable Care Act

Part of the Protection in the Patient Protection and Affordable Care Act comes from the fact that insurers can no longer sell us junk insurance.

It starts with the Essential Health Benefits in the PPACA.

One way for all of us to think about and talk about the PPACA and EHBs are like minimum food safety standards but applied to insurance. We all want safe food, right? Why not some minimum standards for health insurance? After all, health insurers can always offer better plans, but when it comes to minimum requirements, the reason we must have them is that we are being required BY LAW to buy these products from PRIVATE ENTERPRISES. 

For those who complain that these plans deliver benefits that not everyone will ever use, I suggest you look at the choices you’re offered by your employer.

How many health care services do you see there that you will never use? There are at least 6 such covered expenses/types of services in the plan I chose at work. I only had 2 plans to pick from, btw, and both included coverage for expenses like well-child care (my children are adults) and coverage for breast-feeding equipment which my wife better not find herself needing! 

Kidding aside, and to any man who is tempted to respond with anything but support FOR covering women’s health, my advice is that we men keep any comments not in support to ourselves. Actually, we need to change our thinking. No, this is not about restricting free speech. It’s about the fact that it’s high time that we men stopped thinking that we have any sort of role to play whatsoever in making health care or health insurance decisions for or about women.

Another Protection is, of course, the elimination of pre-existing conditions.

Prior to PPACA, anyone who had employer-provided health insurance and then lost their job had a choice to make. None of them were good. PPACA fixed that. 

One choice you might have made was to roll the dice and go without insurance, hoping that you and your loved ones didn’t get sick or injured in the meantime. You knew this choice could also lead to a required physical by the health insurer that your next employer had contracted with to determine even if you’d even be eligible to participate in their plan. The likelihood of a required physical went up, of course, if you got hired but didn’t have insurance at the time. This choice basically left you hoping that nothing known or unbeknownst had happened to you, and that the insurance company wouldn’t then decide to prohibit your employer from enrolling you in their plans. <Insert unapologetic jab at Sarah Palin and “death panels” here.>

Another option you might have when unemployed would be to pay the COBRA premiums (an early attempt to make sure health insurers couldn’t just throw people to the curb) for the same coverage partially subsidized by your previous employer. Based on my personal experience, those premiums for a family of 4 for what I’d call a Chevy and not a Cadillac plan would have been just over $1,400.00 per month a few years ago when I was laid off. 

There was no way I was going be able to afford to make those payments, so I went with my only other option; the open market.

Know what I found there? Junk. 

Junk insurance that I knew I had to have in order to, 1) be able to demonstrate “insurability” to my next employer and their health insurance company and, 2) in case something catastrophic did happen to my family or to me. 

Here’s the plan. It was the cheapest I could find for the four of us. It cost $275 per month, or about one-third of my monthly unemployment benefits. It was from UnitedHealth and was called UnitedHealthOne Saver 70.

Annual deductible: $12,500.00 (Yes, that’s twelve thousand five hundred dollars.)
Benefits paid after meeting deductible: 70% (30% was still on me)
Co-insurance out-of-pocket annual maximum per person: $10,000.00
Office visits: Not Covered
Prescriptions: Not Covered

What this country needs and what offers the greatest benefit to the greatest numbers is what every other advanced country has and that’s single payer health care.

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