Help! I’ve Lost My Insurance and I Can’t Get Up!

indexThe serendipity of the universe never ceases to amaze me. A couple of days ago I gave the keynote speech on healthcare reform at the Texas Medical Association’s CME Association’s annual meeting in Austin. A physician in the audience brought up an issue that was trumpeted in the press when the health care exchanges rolled out for open enrollment; namely, that people had lost their insurance and couldn’t see their doctors. I knew that a very small minority of people had actually “lost” their insurance, and that, in most cases, that insurance provided pretty bad coverage at fairly high prices. But I didn’t want to get into it with him, so I just agreed that yes, the Affordable Care Act certainly has flaws, then moved on to the next question.

If only I’d checked the news before my talk. I could have told him about a Kaiser Family Foundation survey of non-group enrollees (ie, they don’t have employer-provided insurance and bought their own insurance, most on the Exchanges). Among the findings:

  • About  two-thirds of those with non-group coverage are now in ACA-compliant plans, while three in 10 have coverage they purchased before the ACA rules went into effect
  • About half of all non-group enrollees now have coverage purchased from a Health Insurance Exchange
  • Nearly six in 10 (57 percent) of those with Exchange coverage were uninsured before they bought  their current plan. Most had been without insurance for two years or more.
  • Seven in 10 of those who were uninsured prior to purchasing a Marketplace plan say they decided to buy insurance because of the law, while just over a quarter say they would have gotten it anyway.
  • Among those who previously bought non-group insurance and  switched to a new, ACA-compliant plan,  nearly half (46 percent) say their current premium – taking into account government subsidies – is lower than it was under their previous plan, while four in 10 (39 percent) say it is higher, with similar coverage. There is, however, some evidence of a trend toward plans with narrower provider networks.
  • About half of plan switchers (13% of all people in non-group plans) said their previous plans had been cancelled. They are, not surprisingly, the ones most likely to feel negatively impacted by the law.

Overall (as the figure below shows), people were nearly as satisfied with their non-group plans as people with employer-provided health insurance and that, the authors wrote, is likely due to the fact that employers generally pay a greater share of the premium.

Listen, I don’t care what you think about the ACA and healthcare reform, whether you like it, hate it, whatever. All I ask is that you back up your opinion with facts, not anecdotes. And that you understand that the law obviously has flaws, and that it is impossible not to negatively impact some percentage of the 350 million of us.

The ACA is a first step towards reforming a broken health system. It is certainly not the cure. But if we don’t start somewhere, where will we be in 10 years?

The fact is that 8.1 million people signed up for health insurance on the Exchanges, and that, as the Kaiser survey found, the vast majority of them are satisfied with the cost and coverage.

You can read my thoughts on the issue of narrower networks here.



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