FACTS

Open enrollment ended on March 31st, 2014.  It will open again on October 1st, 2014.  It takes approximately 6 weeks for the insurance to be processed before the account becomes active.   You can enroll online (www.wahealthplanfinder.org) or go into a local public health department for personal help.   The one exception is individuals who make less than $15,000 a year.  These individuals can enroll anytime of the year.  

FACTS

The penalty for not having health insurance in 2014 is $95 per person up to $285 for a family (or 1% of a family income – whichever is greater).  However, by 2016, the penalty will increase so that for a family it will cost $2,085 (or 2.5% of family income – whichever is greater).

The Affordable Coverage Act is rolling out but there are a few BUMPS in the road.   Here are some highlights …


1) There will be Universal Health Coverage.

REALITY

- Historically, when this has been attempted at the state level, it has failed.  Currently, there are 48 million in the US who are uninsured.  It is estimated that by 2019 the number will only drop to 31 million.

There will come a time in our lives when due to an unexpected (or expected) circumstance we suddenly find ourselves or a loved one in need of help just to care for our basic needs.  If we are lucky, we may have a sibling, child or parent who lives nearby who can help out.  However, this may not be the situation for everyone and in that case hiring an agency to provide a visiting caretaker is an excellent option.  It is often less expensive then becoming a resident in an adult family home or skilled nursing facility and has the benefit of allowing you to remain in the comfort of your own surroundings.  

According to a survey performed by a New York based research firm called Commonwealth Fund, in 2012 there were 55 million US citizens (30%) without health insurance and another 30 million US citizens (16%) who were underinsured.  Underinsured being defined as having a plan that offered too little coverage while exposing them to high out of pocket cost. 

We need one of the following two options for nationalized health care …

a) Two Tier System

- The government provides catastrophic insurance for EVERYBODY.  This would cover minimum health coverage such as basic primary care.  ED visits would have hefty copays to discourage overuse.

-  Voluntary insurance would exist for those who wanted to have protection against fee-for-service (outpatient) office costs.  The rest of people would have to pay cash.

b) Insurance Mandate

- EVERYBODY must purchase insurance.  No insurance company can reject an applicant – although the rates could be quite high depending on their medical history.  There would be both private and government-sponsored insurance plans available.

As the insurance industry continues to successfully hamper any progress on reform, health care costs continue to rise.  Businesses simply cannot afford to shoulder the burden of these additional expenses – especially during this prolonged.  The answer will be for the employer to purchase cheaper healthplans for the employer which will equate to higher co-pays when visiting the doctor, undergoing tests, receiving therapy or purchasing medications.

The purpose of the Living Will is to have documentation in place for that time when an individual might become unconscious (comatose) and need to communicate their treatment wishes to their healthcare team.   This is called a ‘living will’ because it takes effect while the person is still alive (although comatose) in contrast to the testamentary will which takes place after death.   This legal document only becomes active once two physicians certify that the patient is in an irreversible coma or other terminal condition with no reasonable hope for recovery.

The reality is that 41% of working age adults (20-65) have at least one chronic condition.  Another fact is that an individual is more likely to make use of disability insurance than life insurance.  Unfortunately, many patients do not take advantage of these two important Federal Laws and allow their chronic condition to progress to the point that it becomes a disability which threatens their livelihood.  You can always talk to your human resource department to learn more about these programs and how it relates to your particular company.

Currently, we are spending 20% of our GDP on healthcare (4% for medicare, 1.5% for Medicaid, 14.5% for private insurance).