So a few days ago this guy forced no less than the Washington Post to publish the first in a series of speeches by Jonathon Gruder, MIT economist and giddy architect of Obamacare, in which he called the American voters stupid and easily duped. And, sadly, he’s kind of right. Why is he kind of right?
Basically the American public was opposed to Obamacare at first, but since it’s passed, said public has not really wanted to repeal it, even though the aforementioned architect and numerous other “experts” have found major flaws (PDF) in the program, including multiple typos that have caused serious problems and may soon prove the unraveling of the law itself.
But the real irony of the law is this: In order to attempt to provide a way for the uninsured to access medical care that does not bankrupt them, the law forces many of those who are already insured and use that insurance, into bankruptcy. Call it the race to the bottom, or just go read this poor woman’s story:
A project manager for a manufacturing company, she is one year removed from a cardiac arrest and the subsequent physical recovery is being dwarfed by a near-impossible fiscal recovery. She was sent last Sept. 9 to the emergency room at St. Mary’s Hospital, which was out of her insurance network, instead of to Meriter Hospital, three blocks away, which was covered by her insurance. It’s the difference between a $1,500 maximum out-of-pocket expense and the now-$50,000-plus she’s facing in bills.
“I was unconscious when I was taken to the hospital,” she said. “Unfortunately, I was taken to the wrong hospital for my insurance.
The project manager in question is a 30 year old from Madison, WI. She had insurance, but was deprived of choice in accessing health care due to being unconscious and basically at the mercy of of her Blue Cross Blue Shield plan. Now she’s facing so much debt over her unexpected health crisis that she can’t even get married as she’d like to.
This wasn’t really a problem before the ACA came along. Oh, sure, there were HMOs and in-networks and such, but the difference in pay rate was usually 80% for out of network providers, sometimes after a deductible if the insured chose a high-deductible plan. HMOs these days are extremely pricey comparatively speaking. And they come with lopsided in-network / out-of-network pay schemes by design.
Insurers would much rather you purchase their newly minted “Consumer Driven Healthcare Plans,” (formerly called “high deductible plans”) where you pay for everything out of pocket yourself until you meet a deductible you won’t ever meet UNLESS you have have an unforeseen major health care crisis, or already have major health care issues.
This new system is what people mean when they say they can’t access some of the best hospitals in their area, or have to drive hundreds of miles in some rural areas. They haven’t chosen to pay their health insurance plan a bunch of money for doing basically nothing. They actually expect health insurance to work. The result? “Balanced-billing.”
A News 3 investigation revealed Rothbauer’s situation — what’s called “balance billing,” where patients receive the balance between the hospital charge and what insurance companies will cover — is not unique. While the local insurance companies that represent roughly 80 percent of those who have insurance in our area will offer out-of-network patients in-network rates during emergency room visits, there remains no guarantee they won’t face hefty bills on the back end depending on the treatment they receive.
This must be what Gruder meant when he said that “lack of transparency” was a “blessing.” Here’s how that worked out for Rothbauer:
Blue Cross Blue Shield, said it paid St. Mary’s 100 percent of its in-network rate or $156,000 to cover part of the original $254,000 bill that she incurred during 10 days in a medically-induced coma and another six days in the cardiac unit. St. Mary’s negotiated with Rothbauer to reduce the remainder of her $98,000 bill by 90 percent. This is separate from the bills she received from the doctors, the ambulance, the therapist and others.
Gaines said consumers have little chance to negotiate against the parties in the health care industry as they don’t have the necessary tools.
“I mean, I know this business. I’ve been doing this for a while, knocking on doors, trying to understand this data and I have no ability to do it. None,” Gaines said. “When they don’t even disclose the cost (of services), there’s the cost. There’s the price. There’s the charge. There’s the accepted payment. Lions, tigers and bears, oh my. How do you even know what’s what in this world?”
Bolding mine. Btw, [Meg] Gaines is a health insurance expert who has been doing this for over a decade.
Just in case you missed the irony the first time, here’s what this all boils down to:
The Affordable Care Act specifically addressed emergency room visits for out-of-network patients by requiring insurers to pay the greater amount between the in-network rate and what Medicare would cover. However, balance billing is expressly permitted and Gaines said its results, like what’s happened to Rothbauer, are far too common.
But you know, finding this on the Wreck List at DK and stumbling across a bonus post at Hullabaloo while researching may have been the greatest ironies of all. It’s almost like they can’t read. Stupid American voters, indeed.