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Before we begin this next installment of Health Insurance Issues With Dave, we must briefly mention New Hampshire State Representative Martin Harty. When confronted by constituent Sharon Ormond about planned cuts in local mental health, Representative Harty opined that “there are too many defective people”. He went on to express his wish that we could ship the disabled, the retarded, and people with physical disabilities to Siberia.
Yes, Representative Harty is a fershimmeled 91 year old. Yes, he will serve one, and only one, term. I bring this up to again note that the moment health care is placed into the hands of politicians; the good, the bad and the Harty’s, medical treatment is politicized.
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I had my annual physical this week. I ran in Tuesday morning and had my blood drawn. On Wednesday I spent over a half an hour with Dr. Ken Goodman who performed a thorough exam and an EKG. Let me brag for a second. The results were excellent. The costs for all of this, however, may surprise you.
I haven’t seen this year’s bills yet, but I have last year’s. Last year the Cleveland Clinic billed me and Medical Mutual of Ohio $802.78. MMO has a contract with the Clinic, so they only paid $417.13. I was left with a bill of $32. That is my policy. Technically, preventive care exams are completely covered on my policy, but the Cleveland Clinic always runs a blood test that isn’t part of the package. So I am always left with a small charge.
Many of my clients have similar coverage. Many, but not all. The new law, the Patient Protection and Affordable Care Act, has changed that. All non-grandfathered health insurance policies now cover preventive care completely. How will that impact your policy?
In the simplest of terms, we are adding $417 to $803 of claims and the cost to process the paperwork to your policy. That is up to $67 per month. You and I understand that that will have an impact on your premium. It is true that only a fraction of Americans will take advantage of their free physicals. So you can get yours and hope that all of your friends skip theirs.
The federal government operates in a parallel universe. Their numbers are far different. The Department of the Treasury released interim final rules and regulations on July 19, 2010. This link takes you to thirty plus pages of the Federal Register. Section 5 details Costs and Transfers.
The government determined that individuals with employer-sponsored insurance have, on average, $264 in covered preventive care services. Of that, $240 was paid by insurance and $24 was paid by the patient as a copayment. Making this change, mandating that the exam is totally free, will only result in a $24 shortfall.
My exam, which doesn’t cover all of the stuff that falls under the new law, was a lot more than $264. Yours will be, too. That’s a gap of at least $153. If your current plan covered less than $264 of preventive care, or even no preventive care at all, your gap is much higher. Who will be charged for your free physical? You, of course, will be funding your free exam through higher health insurance premiums.
I believe in the value of routine physical exams. I have been poked and prodded annually for over twenty years. I also believe in routine auto maintenance and oil changes for my cars, but I don’t expect State Farm to cover them. I made a conscious decision to purchase a health insurance policy that includes preventive care. I chose to pay extra.
I believe that you are smart enough to make your own decisions, too. But, the government believes that the benefits of an annual exam, especially the opportunity to have a doctor educate you on the dangers of smoking and obesity, are too important to leave to chance. OK. Sell that.
It is time for the government to explain to the American people how much this program is going to cost us. The answer is not $24. If this really is beneficial, if it is truly warranted, the facts will win out. I believe in the American people. I trust our judgment. We will spend money if we understand why it is in our best interest. But the PPACA has been sold to us as a way to lower our costs and premiums.
That is clearly not true.
My numbers were great. Blood Pressure – 107/74! Resting heart rate of 65. No medications. Anticipated bill - $35. I hope your numbers are just as good, if not better. Diet and exercise can help to control your blood pressure. There may be no way to control that last number, the cost, under the new legislation.
DAVE
www.bcandb.com
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The figures I needed to look up regarding our healh insurance for this year are that our monthly contribuion went up $12.47 per month or $149.64 per year. Granted this is for the two of us, so roughly $75 per person. But the kicker, I think, is that our copay to see the primary (in sickness and in health) went from $10 per visit to $0, yes, zero dollars per visit, whereas to see the specialist is now $35.00 instead of $25. There is no way we each see the primary 7 times a year, maybe twice each. Specialists, maybe twice between us if nothing is going on. (Knock on wood here). The thinking they are trying to get across is the preventative route, but one really only needs to see the doc once a year for those services. I also am well aware that the $98.39 a month I pay for benefits for the two of us is a great bargin, and this includes eye and dental coverage, which isn't great coverage at all, but this will only go to just over $112 per month for both of us when I retire, still a very nice bargin compared to what a lot of people have to pay. So this is the Clinic's answer to the Health Care Reform Act. I also happen to know that the primary care docs are complaining that they are now overloaded because now patients would like them to handle everything, especially the older more complicated retiree who has heart and lung disease etc, because there is no copay for their fixed income. Yes, they can refer them or send them to their specialist, but in the meantime, they have to do the work and cover their ass so nothing happens.
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