Out of pocket costs in Obamacare - feature or bug?

[mota bhai 2,675]

The Obamacare Flaw That Worries Me the Most

Lots of people are talking about the high out-of-pocket expenses in the new Obamacare marketplaces ... The high out-of-pocket costs in some of these plans are a source for legitimate concern. They mean that some people with serious, chronic disease will have real trouble with medical bills.

...

When health care experts talk about “out-of-pocket” expenses, they are referring to co-payments, deductibles, and all the other medical bills that even insured people must pay directly. That $10 you owe when you get a prescription at the pharmacy? That’s an out-of-pocket expense. The $20 for the physician office visit? Same thing. Under Obamacare, there are limits on how big these expenses can get over the course of a year—$6,350 for an individual and $12,700 for a family. The limits are lower still for people with incomes below 250 percent of the poverty line, or about $29,000 for an individual and $59,000 a year for a family of four.

But even with those protections ... people with chronic illness—that is, the people with the highest medical expenses—will still face high costs ... A significant chunk of low-income Americans would struggle to pay the costs associated with serious illness, even after factoring in the law’s protections and subsidies.

Isn’t this a flaw with the Affordable Care Act? You bet it is. In fact, of all the law’s elements, this is the one that bothers and worries me the most. But it’s still a huge improvement over the status quo.

Edited December 11, 2013 by mota bhai

[Pooky 3,840]

They make the insurance affordable. The PPACA was never intended to make healthcare affordable.

[Dakine10 5,452]

I would say it's a flaw. I don't think it's a bug or a feature. It's just a by product of the ACA being designed around the current insurance system model. It's not a bug because it was designed that way. It's not a feature because overuse is not really an issue IMO. If anything, the fear of out of pocket costs can prevent people from going to the doctor to get early symptoms checked out and increase the overall cost of care.

Not to say there shouldn't be out of pocket expenses, but they can't be so high that they inhibit you from using your health plan. All in all it's a good example of why an insurance based model is a poor choice for health care.

[Mr. Big Dog 10,747]

Ever rising out of pocket expenses were part of American health insurance for just about as long as I can remember. It's a flaw in the system. Obamacare didn't change the system, it's build on it and has thus the same flaws the system had all along. People with chrocic conditions may face high out of pocket expenses but now at least their "skin in the game" is capped whereas pre-Obamacare mre often than not their insurance was capped. Once they reached the insurance cap, they got skinned alive. If they ever were able to get insurance to begin with...

[I AM NOT THAT GUY 5,715]

They want young people to pay into the system, not utilize it - design feature.

If it was a good deal, they wouldn't have to fine people to get them to buy into it.