Another reason you should love the Affordable Care Act

Chuck Sheketoff

Outside of a few regulated insurance pools that cover just 24,000 Oregonians, Oregon sets no limit on what an insurer can ask a customer to pay for all covered care.

You have health insurance. It’s through your work. You pay $20 to see a doctor a couple times a year. You pay a few more dollars for meds for your occasional migraine. But not much. You feel lucky. Apparently you should.

A new study, Worry Less, Spend Less: Out-of-Pocket Spending Caps Protect Families in Oregon (PDF) commissioned by Families USA shows that nearly a quarter of a million Oregonians are expected to have excessive out-of-pocket medical expenses this year even though they have insurance that covers their medical conditions. It’s just that they happen to need frequent care, expensive care, or both and their plan doesn’t have a reasonable limit on those out-of-pocket costs.

As noted by Families USA, all of us won’t be lucky all of the time. This year, an estimated 1.5 million Americans will be diagnosed with cancer. So, take another look at that insurance policy you feel lucky to have. Right now, outside of a few regulated insurance pools that cover just 24,000 Oregonians, Oregon sets no limit on what an insurer can ask a customer to pay for all covered care. Some plans voluntarily do include reasonable limits. Others don’t.

A solution? The Affordable Care Act, enacted last year by Congress, sees things from your point of view. Starting in 2014, it puts a cap on what you can be expected to pay at the time you really need medical care. And those caps are set according to your income, so they are fair.

Read Worry Less, Spend Less (PDF) and learn about how the Affordable Care Act limits out-of-pocket costs for Oregonians, including for many working in small businesses, and plays a role in controlling escalating premiums, starting in 2014.

A time machine set to 2014 would be really handy right now for about 250,000 of our friends and neighbors. Maybe even you.

Oregon Center for Public PolicyChuck Sheketoff is the executive director of the Oregon Center for Public Policy. You can sign up to receive email notification of OCPP materials at

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    Hooray! From absolutely unaffordable, to merely incredibly unaffordable! Where do I sign up?

    Family of four earning 66k is subject to $5200 in premiums, and another $5800 in CAPPED out of pocket. So this marvelous ACA has protected people by only leaving them liable for 1/6th of their yearly income. Big huzzahs.

    The best news, if ironic, is that scared Democrats are already talking about killing the mandate--which actually makes it a better bill. But make no mistake: ACA is still awful and is useless long term.

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      Given that according to the Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits 2010 Annual Survey, published in September of 2010 that between 2000 and 2010, the average premium for job-based family coverage grew from $6,438 to $13,770, an increase of 114 percent and there is no cap at all on out-of-pocket expenses...

      a $5,200 premium and a actual cap of $5,800 (if your numbers are correct) is a big step in the right direction.

      Or are you suggesting that it should stay as it was before the passage of the ACA and have it be $13,770 for that family of 4 and no cap on out-of-pocket at all?

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    Oh, Mark... The bill isn't perfect, to be sure. But it's a vast improvement over the status quo.

    You get a life-threatening illness, and you're capped at 1/6th of your income*. That's a far better deal than 100% of your income - and bankruptcy on top of that.

    (*I haven't verified the numbers you assert.)

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    A vast improvement in what areas? Not cost, not enforcement, not protection. The Medicaid threshhold went up, that's good. But we could have done that in 20 minutes without everything else and been much better off. We've added more community health centers, which is good on the ground in the short term, but really only highlights how inadequate the rest of the ACA is--since really the ACA should make such small-bore interventions unnecessary.

    On point, I'm not sure I understand the distinction you make: having your costs capped at 1/6th of your income in an emergency WILL bankrupt you. The other costs of life don't go away when you get sick. You're essentially trying to say that being shot with an arrow once a minute for 3 days, is better than just being blasted with buckshot once. The effect is probably going to end up the same.

    Unaffordable health care controlled by the insurance industry and without any real controls on their behavior, is not my idea of a "vast improvement." It is in fact an institutionalization of nearly everything bad about our current system.

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      So you are suggesting that it should stay as it was before the passage of the ACA and have it be $13,770 for that family of 4 and no cap on out-of-pocket at all, yes?

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    Honestly... I see the GOP axing the entirety of the healthcare laws that Obama put in place so imho nobody will ever see affordable care.

    Btw. When is BlueOregon going to cover Oregon DHS's plans to pretty much kill all funding for developmentally disabled people? They release their proposed budget today.

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    Thanks to the ACA my sister-in-law gets something more than a death sentence if she has a recurrence of her aggressive uterine cancer. She already has had to file for bankruptcy, but without ACA she is dead if she has a recurrence. No doctor will take her and no hospital will take her the next time. Apparently to some people that doesn't mean anything.

    She has the benefit of a risk pool insurance coverage, which will give way to full inclusion for all prior condition coverage when the ACA takes full effect. The rock throwers and the wingnuts seem to think that doesn't mean anything, that it doesn't mean anything when parents can insure there children with chronic illness, that it doesn't mean anything when parents can insure their young adult kids in college or just starting out in the job market, or that it doesn't mean anything that preventive procedures will now get coverage. I don't get these people.

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    What we need is free universal healthcare, not health insurance. Healthcare should be paid directly to the providers out of a national healthcare fund. Take all the money paid to massively incompetent insurance providers and put that in a fund administered by the Department of Health with the concomitant safeguards against fraud. Employment would not be a criteria for care nor would employers have to pay exorbitant fees to provide healthcare. The saving would go toward higher wages and hiring of more employees.

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      I don't disagree. The problem is, how can that be achieved politically?

      The ACA does do good things, and does help real people and worth supporting until there is enough public support for the larger changes. Until we are able to pass the legislation needed to get where we agree we should want to arrive at, the ACA does real good.

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        You are correct. Mark and Gene (and others) never mention which 60 US Senators and majority Representatives are going to vote to pass their preferred alternative to the ACA. Lacking those necessary votes one achieves what one can and then proceeds to the next improvement in the delivery system. The uber-conservatives are fighting the ACA so strenuously not because of what it accomplishes short-term but for what the health care reform movement portends for the future for their corporate sponsors' profitability.

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      Fine,public health care for all, tax funded, but until that happens how about if we have some improvement in what we have so some people can at least survive.

      Eventually most people will be clamoring for an enhanced Medicare system for all as costs for corporate insurance providers, driven by profit and their stock holders goes up. Those who want more can buy their cadillac corporate plans.

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    Besides the issues mentioned here, I know my family has benefited from ACA. Both my wife and my daughter have had cancer - they are clean and healthy today. If God forbid they ever have a recurrence, they will still be covered, and cannot be refused if we change health plans. And since my daughter is 24, a part time student and only employed part time, she is once again covered in our policy, at least for a couple more years. Frankly, given a choice between financial insolvency and a dead family, I guess I'll have to go with the bankruptcy. I'm pretty sure I could recover from that, but not from the loss of my girls.

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    I would be incredibly excited if I could get insurance for my husband and I for $5200/yr. That looks like a bargain to me.

    Just a dose of reality: we're in our 50s, we have a few extra pounds, but we're basically healthy right now. No high blood pressure, diabetes, or high cholesterol. We work for ourselves, but don't qualify for group coverage because we can't guarantee that we'll both work 20 hours a week when the work isn't there. We applied for private insurance, but we can't even get it if we want to. I've seen people turned down for acne, asthma, herpes(!), so if you've had garden-variety back pain that might benefit from some PT, they really don't want to talk to you. Especially if you 're over 35.

    If it wasn't for the Oregon high risk pool, we'd have to go without for six months to get in the federal plan. But we're lucky--we were able to sign up for OMIP.

    What does luck buy you? The privilege of paying $1,032 per month to cover two people. Oh, and we each have $1,500 deductibles. And separate $1,000 prescription drug deductibles. The 30% co-pays kick in after that. That's the least expensive plan. We can get by, but even this plan is way out of reach for most people.

    Nice, huh? The Republicans say they want to encourage entrepreneurs. Having to set aside nearly $20K a year just to cover medical kind of puts a damper on starting a family business if you don't have deep pockets. I'm really looking forward to 2014 when we can get private insurance. At least it should be a bit cheaper.

    That all said, bring on single payer or at least the public option. I am more than ready. Our entire healthcare system is ridiculous.

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      But Jenny, according to Mark up-thread you are better off with the paying more currently than what you will under ACA because it isn't single-payer. Because if it isn't perfect, it's worthless... or something.

      (FYI, I would love single payer if we could get it into law)

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    It's a start. The ACA doesn't really address the cost structure of our system. The insurance companies are part of the problem, but they're not the ones setting the costs for care. Too much technology, Big Pharma, over-reliance on specialists...there are a lot of moving parts to the puzzle. I think the root of it is that as Americans, we support the concept of profit on healthcare. It's not like you get to choose when you have a need for it, and once you are in the system, you are offered no cost information or any other info that would enble you to be a smart consumer.

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