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Affordable Care Act: The Good, the Bad, and the Parts that Don’t Work according to Doctor Kevin Most

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(AP / NDN)

Doctor Kevin Most joined the show this morning while Steve, Andrea, and Pat Brady were live from the Caucuses in Iowa. We discussed how Obamacare actually gets played out in the healthcare system, and what the candidates promising to repeal the Affordable Care Act would have to do to replace the controversial legislation. You can read more from the Doctor below.
Deadline to have signed up for the ACA was Jan 31, those who did not will now be looking at a fine of $695 or 2.5% of your household income whichever is higher. Remember these fines were much lower the first 2 years of the ACA. In 2014 it was a $95 fine or 1%, in 2015 it rose to $325 or 2% of household income. So each year this has gone up to incentive individuals to participate.
Depending on your income and where you live a large portion of the monthly premium may be subsidize to a much lower level and may approach zero. For most individuals we are talking about the lower wage worker, who works at a company where insurance may not be offered. In the past they could not afford insurance at all as the premiums were very high, the federal subsidy helps lower the cost and attempts to make it “affordable”. This is a relative term, many of these individuals are raising families and living paycheck to pay check. The additional cost of a premium may impact their daily living expenses, even if it is highly subsidized.
As patients start to make a decision on choosing a plan, they will often look at what their monthly premium would be, as this is the amount they are responsible each month. The difficult part is the large deductibles that are associated with these plans. If they choose a bronze plan which has the lowest monthly premium also has the highest deductible which in most cases is between $5,000- $6500 each year. As you move up plans to a silver or gold plan the monthly premium increases and the deductible decreases. The vast majority of individuals in the past 2 years have signed up for the silver plans, these plans have deductibles that are$2,000-3,500/ yr. 20 % of individuals chose the bronze plan with those $6,000 deductibles.  It has been said that most americans could not afford to be hit with a $2,000 bill.
Do the plans protect the individual and family from a catastrophic illness, it absolutely does. Patients will not have the massive bills that can be hit when an individual has a major illness. However it does impact that individual that has some health issues that will have some costs. The plan does provide for no cost preventative care including physicals and cancer screening,  these screens can often identify problems that are treatable which for the long term health of the country is good.
One of the big concerns is keeping your doctor and keeping the hospital you want to receive care at.  President Obama made the statement that you can keep your doctor, that is true as long as your doctor is in the plan that you choose. All doctors are not in all plans. Many of the plans are restricted or have what we call narrow network. Some of the largest plans have blocked some hospitals from providing care for the individuals they have insured. The difficult portion of this is that the websites are not always accurate with physicians that are in the plan and that hospitals may opt out of a plan based on the rates they are willing to pay. Many hospitals will limit the number of plans they will participate in due to the administrative costs as well as how much the plans are willing to pay the hospitals for care.
How do we improve the ACA?  This is a tough question, as it impacts everyone. Do we make the premiums higher? Do we mandate some hospitals to participate?  Are we ready to limit some care, cut back on somethings we are now expecting?
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