Tuesday, December 28, 2010

Obamacare: both more and less than it was cracked up to be

Nancy Pelosi said that we'd have to pass it to find out what was in it. And that is certainly true. And what we're finding is that it hurts us more and helps us less than it was promised to.

If you're one of the millions who used a health savings plan to buy over-the-counter medicine with pre-tax earnings, now you're going to have to have a doctor's prescription for those items.
Thanks to Obamacare, the one bright light in many people’s complicated and burdensome health-care spending plans is about to be taken away.

That little bit of tax-free medical spending that some of us have enjoyed for years, the health savings plans and the pretax money they provided for over-the-counter remedies . . . cough syrup, saline solution and even toothpaste . . . now will require a doctor’s note.

“It’s too bad,” said Kim Martin of Roxbury, shopping yesterday in the Egleston Square Walgreen’s, “because I really liked having a health spending plan.”

Martin was out in Sunday’s blizzard to stock up on aspirin, fish oil and as much over-the-counter medicine as she could carry home, before the new restrictions kick in Jan. 1.

Thanks to the new federal health care reforms, starting next week, Martin and millions of others will have to pay about 40 percent more for their drugstore purchases.

And now, thanks to the pending change in federal law, she is trying to decide if she’ll stick with the program.

And she’s not alone. I’m right there, too, bemoaning the loss of the one thing I liked about all of my health care spending options.

I liked the idea of setting aside a pool of money each year to pay for health care.

I liked having money taken out of my paycheck before taxes eat it up. I also like the feeling, at a time when every bill seems eye-popping, that the less I resort to the medical system, the more money I have to spend on things that keep me healthy.

It’s what the people who crafted these plans envisioned years ago. They said that the special accounts would make people more aware of health care costs, and, as a result, help people make better health care decisions.

Then there’s that added perk of the account-issued debit card, which I pull out whenever I need vitamins or Band-Aids.

As of next week, it is only good for medical visits and prescriptions. The Affordable Care Act of 2010 will bar consumers from using their tax-free health care dollars on over-the-counter medicines, unless they have a doctor’s prescription for that purchase.

This means that I’ll need a doctor’s permission if I want to use my health savings money to buy Tylenol PM, or even Excedrin Migraine.
Having to go to a doctor rather defeats the point, doesn't it?

And if you thought that all of this agony of changes in the health care system were worth it if we could help people who couldn't get health insurance because of pre-existing conditions and you ignored the critics who said it would be cheaper to craft a smaller plan targeted at just those people, this story might surprise you. It turns out that there seem to be a whole lot fewer of such needy individuals than forecast.
An early feature of the new health-care law that allows people who are already sick to get insurance to cover their medical costs isn't attracting as many customers as expected.

In the meantime, in at least a few states, claims for medical care covered by the "high-risk pools" are proving very costly, and it is an open question whether the $5 billion allotted by Congress to start up the plans will be sufficient.
Perhaps people don't know about the plans or perhaps they're nervous about signing up for plans that are presently under a federal lawsuit. Those are the arguments being put forth by the proponents of the law. But it sure isn't working out as predicted.
Under the sprawling health-care legislation that Democrats pushed through Congress in March, the special health plans were designed as a temporary coping mechanism for a small but important niche among the nation's 50 million uninsured: people who have been rejected by insurance companies because they already are sick.

Twenty-seven states have created their own high-risk pools. The rest used an option in the law to let their residents buy coverage through a new federal health plan.

In the spring, the Medicare program's chief actuary predicted that 375,000 people would sign up for the pool plans by the end of the year. Early last month, the Health and Human Services Department reported that just 8,000 people had enrolled. HHS officials declined to provide an update, although they collect such figures monthly, because they have decided to report them on a quarterly basis.

"Like the rest of the country, we thought we'd have pretty much a stampede. That obviously hasn't materialized," said Michael Keough, executive director of North Carolina's plan. With nearly 700 participants, it is among the nation's largest so far, but it has one-third of the people expected by now.

According to interviews with administrators of nine of the state-run plans, only one - Colorado's - is close to its forecast enrollment. Maryland, the only jurisdiction in the Washington area that has created a plan, has 97 participants, compared with 19,000 in an older state high-risk pool, according to Kent McKinney, who directs both. HHS's November report said that Virginia had 75 participants in the federal plan. The District had none.
This is one of the parts of the plan that is supposed to be winning support. It was set to go into effect early because this was seen as such a crucial need. Some conservative think tanks like the idea of high-risk pools and some states already have them. It's the pools set up by Obamacare that seem to have trouble attracting applicants. Maybe there a lot fewer of such individuals than estimated. Maybe we didn't need to upend the entire health care system with all the consequences that we're hearing about on a regular basis to help uninsured people with pre-existing conditions. Maybe there could have been a small program targeting just those people instead of remaking the entire insurance market. Those are the types of questions that could have been addressed if this bill had been written in the regular way after hearings and consultation instead of being crammed through in its unread form on a partisan basis.