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.
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 goal is to have as many healthy young individuals who previously were not insured go purchase health insurance. In theory, they will underutilize services and the insurance companies will make money on them. This will offset the money the insurance companies will lose caring for the older adults (age 55-65) who will be paying relatively low premiums but going to the doctor and hospital more frequently for care.
Although there is close to 75 million US citizens between ages 18-65 without insurance, at this time only 6 million have signed up. The government will encourage citizens to sign up by issuing a penalty for those that do not and will also pay the difference (subsidize) the high-cost of the premium for the older adults (age 55-65). For example, I have a patient who is married and as a couple they earn $76,000 a year. Prior to 2014, they chose to go without health insurance as their combined premium was $1400 a month. However, they qualify for a subsidy (their family income is within four times the poverty level). They now only pay $350 a month. The government writes a check to Lifewise for $1050 each month to make up the difference. Obviously, it’s unclear how long the government can continue to afford this generous program but they are likely hoping that once a critical number of younger adults obtain health insurance that they can stop this program.
This entire problem does not address the underlying problem which is escalating health care costs. The two healthcare systems (Providence, UofW, Swedish) and the Insurance Companies (Lifewise, Blue Cross) only gain from this new arrangement. There are now 76 million new insured customers added to the business of healthcare. As I see it, at this time it doesn't appear that the insurance companies are losing any money on the premiums since the government simply subsidizes the difference.
Health care costs will continue to rise and premiums will go up. We may have Universal Health Care but it will come at the cost of higher premiums which will be shared by employers, employees and now even the unemployed.
A GLINT OF HOPE
Maybe this only represents the bargaining and concessions necessary to improve the American healthcare system. It’s possible the US government will get tough with the insurance companies and make them more transparent about their profit margins. At the very least they could stop writing out the subsidy checks and just demand the insurance companies accept the older adult patients. This would motivate the insurance companies to help regulate the healthcare systems which continue to inflate healthcare costs.
IN AN ALTERNATIVE UNIVERSE
How come we can’t just have a universal catastrophic health insurance program? The government could even make that mandatory if they wanted. Why can’t we remove the obligation for businesses to provide health insurance to their employees? In this Shangri-La, people would just go to a health-provider and pay cash. There wouldn't be any pre-approval, no preferred provider list, no in-network provider lists, no complicated billing. It would mean the end of the health insurance industry (other than catastrophic insurance). And … that’s why Shangri-La will never come to be. So instead, an inefficient system grows even more complicated with the entry of the US government.