Adventures in Obamacare II
by Seth Rogovoy
By now you’ve undoubtedly heard all the horror stories about how the online exchanges aren’t working or worse. This hasn’t been my experience, but then again, mine is only one individual case among millions. I successfully signed up for health insurance on the New York State online exchange, and my insurance, with which I am happy (at least so far, not having used it yet), takes effect on January 1, 2014. So I just need to stay injury-free and healthy until then, and then all hell can break loose.
First of all, I waited a good week-and-a-half or so before even trying to log in to an online exchange. The hysteria surrounding the October 1st starting date was ridiculous. There was no reason to hurry and sign up immediately. In order to qualify for health insurance beginning on January 1, 2014 – the earliest date it is available through the exchanges – the deadline one has to meet is December 15. And it’s not like an iPhone, where if you don’t get in early, you have to wait until they make more heath insurance in Chinese factories. So I waited for the initial dust to settle, and logged in around October 10 or so.
Secondly, as I live in the great Empire State, my destination was not the Federal exchange – which was set up as a default for those who live in states unable or unwilling (mostly unwilling, mostly Republican) to set up their own statewide exchanges – but the New York State exchange. So my experience is only with that. Most of the horror stories we are reading about in the press are about the Federal website – and make no mistake about it, what we are reading about is not Obamacare or insurance itself, but simply … problems with websites. Perhaps badly designed and implemented websites, but websites all the same, and websites that can and will be fixed.
After I signed on to the exchange and answered a few simple questions – where I live, social security number, nothing that should stump anyone – I was presented with options for my income level. Since last year I earned more than 400% of poverty level, I am not eligible for any subsidy. There were four tiers of insurance from which to choose: bronze, silver, gold and platinum. I took a quick look at the bronze plans, and then at the gold and platinum just for laughs, but quickly decided that I should opt for a silver plan.
I can’t complain, therefore, that at $480 per month, my insurance isn’t “affordable” or too expensive. I could have opted for something considerably less expensive. But, as with anything, you get what you pay for. This whole “Obamacare” thing is already a compromise, remember – it’s all a sop to the GOP and the insurance industry, as it’s something well short of single-payer national health insurance, which is what President Obama, and Hillary Clinton before him, really wanted (as does the majority of the nation, and as most of the civilized world has had for years).
Even once I narrowed down my choice to plans in the silver tier, there were a host of options from which to choose, and a handful of different insurers, including recognizable names like Blue Cross and some I hadn’t heard of before. And each insurer then offered several plans within the tier. The insurer I wound up choosing offered at least six or eight different options all within the silver tier alone.
Frankly, it was a little overwhelming, all these many options. One has to remember that there are people whose jobs it is to navigate this sort of thing for the rest of us. At a lot of companies, these are the folks in human resources or benefits administrators. Smaller businesses often engage the services of outside experts to find plans that best suit the business’s employees. So even though the New York State exchange succeeds in spelling out all the many plans, their costs and benefits, with comparative analysis, it’s almost too much information for a layman. Then again, better too much than none at all, and perhaps the so-called Navigators can help make sense of it all (although I doubt it) – here is an opportunity ripe for entrepreneurial or industrious types, helping advise people about what plan to choose.
I narrowed my choice of insurer down to one pretty quickly, as I knew in advance in which plan my beloved primary care physician is enrolled (I was tipped off by a very helpful physician’s assistant in the doctor’s office, who also told me it was a good insurer), and if I could, I wanted to be able to continue on with him and the great medical group he works with. The best way to determine this is a quick phone call to your doctor’s office rather than trying to figure it out through the online exchange (although just for kicks, I did just that, and indeed I found my doctor’s name listed, in spite of reports that say you can’t find this information online – I did). Ask your doctor’s office what insurance they recommend while you’re at it, since they are the ones who will have to be dealing with the insurer once your policy is in effect.
From there I dug around and tried to compare the various silver-tier options offered by CDPHP, the insurer I chose. The major difference were price, but also how the plans were structured –some had specific co-pays for specific items (office visits; ER visits; prescriptions) in dollar amounts, while others were based on percentages of fees. I opted for the former, which may or may not have been the best choice. I don’t really have the brain for this sort of thing; there was only so mu
time and mental effort I could expend on my choice, and at some point, I just fished and cut bait and opted for the plan that seemed best for me overall.
So that was it. The whole thing took me about two hours over the course of two days. A week or two after I signed up, I got a confirmation in the mail, and an invitation to start paying my monthly premium (I will wait until next month, thank you very much).
As to whether or not $480 is “affordable” health care, that’s a tough question to answer. For the last 15 months or so I haven’t paid any monthly health insurance premiums at all. I haven’t incurred any significant medical expenditures, either – just a few office visits and one blood test (which fortunately ruled out anything wrong after I had some kind of metabolic episode), out-of-pocket costs for some maintenance prescriptions (my co-pays will probably be significantly less than what I have been paying), and that’s pretty much it. Do I have an extra $480 lying around at the end of each month that I can apply to my insurance premium? No. Will I have to figure out a way to make an extra nearly $500 a month (after taxes) or find $500 in monthly expenditures to cut, or some combination of the two? Yes.
Will it be worth it? I think so. It’s got to be better to have health insurance than not, and these plans have been examined and approved by the government – any plans on the exchanges have to meet federal guidelines.
Is this the optimal way to dish out health care? Absolutely not. Everyone knows that the best and most efficient system would be single-payer, with everyone in the same risk pool, which would level out costs and expenditures, while of course saving billions in totally unnecessary administrative costs in doctors’ offices as well as in propping up the insurance industry – which is what our monthly insurance payments are in effect doing.
But until then, this is the best we’ve got. And so far, in my experience, it’s not bad, and yes, it works.