Here's what I think: Every American should be able to afford and pay for health care. And I thought everyone was getting that opportunity with hospitals for those who couldn't pay... and I've heard that if you go to any hospital you can't be denied treatment. I've known people who did not pay for open heart surgery in the same hospital my husband went to and our insurance paid. I was among that number of uninsured for a brief period of time and could wind up there again. I got enough health care to keep me healthy. But there were some medications I couldn't afford. I lost my health insurance and couldn't get it on my own due to (flimsy in my opinion) pre-existing conditions. But there are stories of people who haven't gotten treatment they needed. Why is that? So yeah! We need something... but not just anything.
I don't want to sign up for something before I read the fine print. And I don't think I got that opportunity before this Obamacare was thrust upon me. I'm not sure what the answer is. Surely there's someone out there smart enough to figure it out though.
For those of you who want to know what my source is, here you go: http://www.ncsl.org/documents/health/ppaca-consolidated.pdf. If you know of a better document to read, let me know. This is supposedly the consolidated bill at 907 pages. I don't think I could make it through the complete document in my lifetime!
So right off the bat, on page thirteen where the contents pages end and the meat of the document begins with amendments, we get information about annual and lifetime limits. It says insurance companies can't set them. But for everything? NO! There is language here such as:
‘‘(2) ANNUAL LIMITS PRIOR TO 2014.—With respect to plan years beginning prior to January 1, 2014, a group health plan and a health insurance issuer offering group or individual health insurance coverage may only establish a restricted annual limit on the dollar value of benefits for any participant or beneficiary with respect to the scope of benefits that are essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act, as determined by the Secretary. In defining the term ‘restricted annual limit’ for purposes of the preceding sentence, the Secretary shall ensure that access to needed services is made available with a minimal impact on premiums.
Essential health benefits... what are those? A check up with my doctor? A mammogram once a year or colonoscopy every two? Who says what's essential? My doctor? Ummm I don't think so. It says above that this will be determined by the Secretary. Who the heck is the Secretary that decides what treatments I can and can not have? Under section 1302 B those have been established... let me see if I can find that list because I sure haven't found it yet. When I find it I'll report back.
But here's what you need to know for now. Don't think you've got carte blanche insurance. If you think insurance companies are going to be paying through the nose for anything you and your doctor want, think again! There's a list that is established somewhere and will be edited as deemed by the "Secretary" of what they have to cover. So for those of you that have fantastic coverage now, you're going to see less coverage and pay more out of pocket in order to cover more people. I've already started paying more in the last two. Somebody's gotta pay, right?
So say you have breast cancer, but you're not in immediate danger because it's stage zero and not fast growing. If that isn't listed under the essential health benefit, what are you going to do? You're probably going to live with it until it becomes a threat because the out of pocket costs are going to be too high.
Now this takes me to a little research I did on the term "comparative effectiveness". Supposedly, this list of essential health benefits coverage can be determined by a committee of people who determine the comparative effectiveness of the treatment prescribed. I'll break this down in a separate blog because it's deep folks... really deep. If you want to Google it and learn for yourself, go ahead. It sounds logical enough. But it scares the daylights out of me because it takes my choice of my physician out of the equation. My doctor may be the most brilliant mind in the the world and most experienced on the subject of my condition. But if this team of experts, or the "Secretary" doesn't add his treatment to the list, I'm not covered for what he recommends.
To me, I may as well go to the company nurse. (I'm not knocking you nurses! You can be brilliant too. I know because my sister is one. She's my pre-doctor!) But anyone can read a list of prescribed treatments. How many options can there be? And is it going to take into account my body's response to said treatments?
You tell me... is this a good thing? I'm cringing at the thought of where that kind of power can go. So I really don't think so. But you can decide for yourself. I just have an opinion of my own!
Enjoy this beautiful day!
J
No comments:
Post a Comment