High-deductible nightmares: the health insurance crisis partisans ignore

dwoe-300x241While political partisans pound without pause for extreme changes in the Affordable Care Act, Medicare, Medicaid, and other government programs that seek to assist the poor, sick, children, and others with access to health care, they’re ignoring the medical nightmare that’s afflicting ever-rising numbers of middle- and upper-class Americans who get their health coverage at work: high-deductible health insurance.

Families long have been staggering under sudden and sizable medical expenses they may be forced to bear because they need health insurance and only can afford their employers’ offerings by reducing their monthly premiums with high-deductible policies. They’re betting they won’t be hit with thousands of dollars in out-of-pocket medical costs.

They’re losing that wager. Often. A lot. And dealing with dire consequences. As Bloomberg News Service reported:

Today, 39 percent of large employers offer only high-deductible plans, up from 7 percent in 2009, according to a survey by the National Business Group on Health. Half of all workers now have health insurance with a deductible of at least $1,000 for an individual, up from 22 percent in 2009, according to data from the Kaiser Family Foundation. About 41 percent say they can’t pay a $400 emergency expense without borrowing or selling something, according to the Federal Reserve. The bottom line: People … simply can’t afford to get sick.

The health care system, notably employers and insurers, have shifted cost burdens onto all levels of American workers, shafting them with exposure to serious financial and personal risks, as Bloomberg noted (see the news service’s chart, above):

Since the early 2000s, employers have mostly embraced high-deductible health plans. The thinking has been that requiring workers to shoulder more of the cost of care will also encourage them to cut back on unnecessary spending. But it didn’t work out that way. In the wake of the 2008 financial crisis, many families were hard-pressed to meet their soaring health-insurance deductibles. At the same time, studies show that many put off routine care or skipped medication to save money. That can mean illnesses that might have been caught early can go undiagnosed, becoming potentially life-threatening and enormously costly for the medical system.

To be fair, US companies find themselves under the gun due to a prevailing economic philosophy that forces them to consider shareholder value and interests above almost all other concerns, including workers’ well-being. CEOs must pare at expenses while jacking up revenues or shareholders — actually a stock ownership benefit accruing mostly to a wealthy minority of Americans — boot them out the door.

Executives and companies themselves are asking what kind of harmful system they’ve created and labor in, in which, yes, enterprises save a bit on ever skyrocketing health care costs, but they do so knowing they’re imperiling the health and finances of a crucial component of their business: their people.

In my practice, I see the harms that patients suffer while seeking medical services, and their struggles to access and afford safe, efficient, effective, and even excellent medical care. Americans have found some help and solace with the sometimes-overpowering weight of their medical bills by a long-accepted and popular sharing system — appropriate and equitable health insurance, including via public exchanges provided under the ACA.

But Republicans, in Congress and now the Trump White House, argue that government has no role in health care, and they have pushed a Darwinian policy agenda that would repeal the ACA, its coverages and protections, and, as of now, offer little in their stead. Americans have embraced aspects of Obamacare such as it bars on insurers’ declining coverage due to preexisting conditions and requiring policies to provide minimum protections, including low-cost or free preventive care and health screenings. The ACA also has other elements that protect consumers from bankrupting medical costs.

Partisans would strip patient-consumers of these beneficial protections under the ACA. How long will employers, if Trump officials eliminate preexisting conditions and promote skinny or junk health insurance alternatives, keep offering workplace health policies that really help workers and don’t leave them in the lurch when they most need medical cost help?

At a time when US corporations are showing some of their healthiest balance sheets in a long time, when their borrowing costs are low, and they’re flush with the GOP-approved tax cut that accorded wealthy companies a $1 trillion tax cut (not to mention that the super-rich also benefited from it), would it be too much to ask lawmakers and big company bosses to toss a little of their lucre toward their workers?

The midterm elections may be among the most important in recent days, and not just because control of a balanced US Supreme Court may have gone on tilt with the retirement of Justice Anthony Kennedy.  Voters may wish to think hard how partisans have abandoned so many Americans to high-deductible plans at work, even while attacking health care access for the poor, chronically and mentally ill, as well as the aged and vulnerable kids. Even as independent analyses of these measures finds them costly, ineffective, and harmful for Americans’ health and well-being, a federal judge has blocked Kentucky, a pioneer in these work requirements, from implementing its Medicaid changes.

The Trump Administration has encouraged states to push Medicaid rules to force ailing recipients to show if they can or can’t work, to pay qualifying sums they can’t afford so they have “skin in the game” in paying for their care, and other such Draconian steps. The judge called Kentucky’s Medicaid work rules “arbitrary and capricious,” finding that officials failed to pass two key tests in assessing their regulations — did they cost coverage, and did they promote coverage under the program. They flouted both requirements, wrongly ignoring ample, submitted evidence of the harms the rules would cause to Medicaid patients.

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