Insured, but Not Covered – NYTimes.com

I didn’t write what follows, the New York Times did. On the other hand, I must take a bit of the credit because I and many others with experience with health benefits observed all this … three years ago. Nothing is free, you squeeze the balloon and it expands on another side. And most important and relevant, health insurance premiums only go down when claims go down so if premiums are lower, you are either not using health care or when you do, you are paying a larger share of the cost.  It’s a very simple equation. [Which by the way, is also why all this talk about competition among insurance companies is nonsense].

When it sold Obamacare to America, the Administration attacked health insurers, their salaries, profits, “discriminatory” practices and the like.  All of which was quite irrelevant to the premiums people pay.  What it forgot to tell you was the truth. But now you know, don’t you?

“The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources — such as separate deductibles for network and non-network care, or payments for drugs on an insurer’s ever-changing list of drugs that require high co-pays or are not covered at all.

For some, like Ms. Pineman, narrow networks can necessitate footing bills privately. For others, the constant changes in policy guidelines — annual shifts in what’s covered and what’s not, monthly shifts in which doctors are in and out of network — can produce surprise bills for services they assumed would be covered. For still others, the new fees are so confusing and unsupportable that they just avoid seeing doctors

It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills. Insurers can no longer deny coverage to those with pre-existing conditions, for example. And the new policies cap out-of-pocket spending so long as the patient receives care within the plan. Most important, the act has offered health insurance to an estimated 10 million Americans who did not have any, often by expanding Medicaid or providing subsidies

But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.”

via Insured, but Not Covered – NYTimes.com.