Obamacare: An Insurance Card, but No Guarantee of Healthcare Service

President Obama signs Affordable Care Act into law on March 23, 2010.

President Obama signs Affordable Care Act into law on March 23, 2010.

The Affordable Care Act, passed into law in 2010, expanded health insurance coverage through establishing health insurance exchanges and establishing a mechanism for states to expand Medicaid eligibility. As I’ve noted before (see http://tinyurl.com/79gu6ef and http://tinyurl.com/qhl69ao), this law was a boondoggle for the insurance industry, netting these businesses billions in extra profit.

Unfortunately, having an insurance card doesn’t mean you have access to healthcare.

The ACA’s standards for “network adequacy” are so loose that people who now hold health insurance cards obtained through the exchanges find that only a very limited number of physicians and hospitals accept their insurance. This state of affairs adds insult to injury, as people who obtain health insurance through the exchanges are paying exorbitantly high premiums — premiums that the insurance companies threaten to raise if they are forced to include more services in their coverage.

The same problem exists for those with Medicaid. Since passage of the ACA, 27 states have expanded Medicaid eligibility. Most states hire insurance companies or healthcare providers such as hospital systems to manage the clinical care of patients enrolled in their Medicaid plans. Federal regulations require the states to provide adequate access to all services covered. However, the states are allowed to determine what’s “adequate.”

As a result, even the limited federal oversight of health insurance exchanges (itself inadequate to ensure access to care) is lacking with respect to state Medicaid programs. Medicaid patients find themselves with extremely small numbers of physicians willing to care for them, and these patients often must travel long distances in order to find these services.

We need to take profit out of the equation for delivering healthcare services. Let’s get rid of insurance companies who limit services to ensure higher profits. Let’s get rid of the fee-for-service payment system in which physicians limit or refuse to care for Medicaid (or Medicare) patients because the fees are low.

We need a national healthcare system based on universal health insurance coverage. Healthcare is a right, not a privilege.

Sunday, August 23rd, 2015 at 20:26