OBAMACARE II

© 2013 Rick Adamson

By Rick Adamson 12.24.13

Obamacare specifically states that any health insurance policy issued (effective) after December 31, 2013 must contain all of the mandated essential benefits (see list below) required by Obamacare.  The one exception is the so called “grandfathered plans.”  These are plans issued prior to March 24, 2010, which have not changed since issuance, with minor exceptions.

Since health insurance policies routinely change provisions, some times annually, in order to manage costs, e.g., changing deductibles, out of pocket costs and prescription coverage, among other things, very few, if any, policies will be grandfathered.

Take my situation as an example, I have a small group plan and it renews April 1, each year.  So, my plan was in effect on March 23, 2010 and was subject to being grandfathered.  My plan renewed on April 1, 2010, April 1, 2011, April 1, 2012 and April 1, 2013 so there have been four opportunities for the plan to be changed (in the slightest) and bust out of the grandfather provisions.

I received a letter from our provider dated November 12, 2013, saying that our plan was a non-grandfathered plan and would no longer be available. It further stated that we would be offered a new plan that contained all of the provisions of Obamacare. No quotation was provided but I expect it any day.

So, somewhere along the line our plan was changed on one or more of the renewal dates by us or the insurance company so that our plan was considered a non-grandfathered plan.  You can see that given the many opportunities to bust the grandfather provisions during the last four years during which time we were not aware that the regulations that came out severely restricted the changes that could be made to a plan.

This fact has become abundantly clear to the individual and small business markets already.  The large group market received an unconstitutional waver/delay by President Obama.  Those plans will not feel the effect of Obamacare until 2015 which is conveniently AFTER the next major election cycle in November 2014.  But, believe me, they will be adversely affected just as my group plan was.

You see that almost everybody (150,000,000 people or more) who currently have health insurance will be affected by Obamacare when it is fully implemented.  It would have been so much more cost effective and less disruptive to the public if we had just said that the 30,000,000 or so uninsured would be provided free or low cost insurance by the Feds leaving the vast majority of folks alone.

But no, leave it the Feds to screw things up.  So far about 6 million people have lost the coverage they once had (including my group) while about 1.2 million people have signed up for Obamacare.  Of the 1.2 million approximately 960,000 have opted for the Medicare route.  You see, the requirements to qualify for Medicare were loosened by Obamacare so that many more people qualify for free coverage (more welfare).  Of the other 240,000, the majority qualify for "subsidies" which are a reduction of income taxes or an increase in refunds--more welfare.  If you pay income taxes you are paying for the insurance for these people.

In essence, what we will end up with is another massive entitlement program intertwined with a massive bureaucratic government controlled program that affects 1/6 of the economy and hundreds of millions of people when it could have been limited to only the uninsured.

The essential health benefits include at least the following items and services as well as unlimited dollar amount of life time coverage and coverage of preexisting conditions:

·             Ambulatory patient services (outpatient care you get without being admitted to a hospital)

·             Emergency services

·             Hospitalization (such as surgery)

·             Maternity and newborn care (care before and after your baby is born)

·             Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

·             Prescription drugs

·             Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

·             Laboratory services

·             Preventive and wellness services and chronic disease management

·             Pediatric services

You will pay for these essential benefits no matter you age or gender. In, other words, whether you need them or not.