If you think the Obama health law won’t affect you because you have private insurance, keep reading. The Department of Health and Human Services announced final rules for private insurance last month. The federal government will have control over your care. Sec. 1311 of the law empowers the Secretary of Health and Human Services to dictate how doctors treat privately insured patients and what questions patients must be asked. Your doctor will enter your information into an electronic data base, your doctor’s decisions will be monitored for compliance with federal guidelines, and your doctor may have to choose between what is best for you and avoiding a government penalty.
1. Ask your doctor about keeping two sets of books, if you tell your doctor things you wouldn’t confide to anyone. Otherwise your electronic record will include everything and be seen by thousands of eyes. Have depression, erectile dysfunction, or a drinking problem? Your chiropractor will see it. So will thousands of nonphysicians. President Obama’s January 16 Executive Actions to curb gun violence deemed healthcare privacy protections “unnecessary legal barriers,” making it clear federal agencies will use health information for non-health purposes, such as background checks.
2. Line up your doctors now, if you’re a baby boomer. If you wait until you turn 65 and go on Medicare, you won’t find a doctor willing to treat you. Doctors will be paid less to care for seniors than any other patients.
3. Insist on a specialist, if you have a heart problem. Obamacare requires insurers to implement HMO-like controls that will reduce use of specialists. Recent research shows that patients with unstable angina do far better at avoiding heart attacks when they are seen regularly by cardiologists.
4. Brace yourself for less care at the hospital. Cuts to Medicare pay for over half this law, including a whopping $247 billion reduction in what hospitals will be paid. That will push hospitals into financial crisis, warned Richard Foster, Chief Actuary of Medicare. Nurses will be spread thinner, and patients of every age will wait longer for help.
5. Ask your employer whether your on-the-job coverage is going to be dropped. The law compels employers with 50 or more full time employees to provide a package of benefit that costs twice as much as what many currently offer. Some employers will opt to pay a penalty instead, and notify you by October 1. Amazingly, even federal actuaries admit the employer mandate will result in fewer people having employer coverage.
Some employers are already adjusting the size of their workforce to avoid the mandate, or pushing workers to part-time status (under 30 hours a week). Employers’ obligations in 2014 will be determined by the size of their 2013 workforce.
6. Avoid Medicaid. If you lose on the job coverage, you’ll either be directed to an insurance exchange or dumped into Medicaid. “Dumped” is the right word, because Medicaid is often inferior coverage. Research shows that surgery patients on Medicaid are 50% more likely to die than surgery patients with private coverage and more at risk of dying even than uninsured patients.
Citizens with household incomes below 133% of poverty ($19,000 for a single person and $33,000 for a family of four) are ineligible for subsidized private plans on the exchanges. They have to settle for Medicaid. Legal immigrants with low incomes get a better deal. The law makes them eligible, because otherwise they would be uninsured. Medicaid has a 5 year waiting period for newcomers.
7. Don’t be bamboozled by fancy marketing. An exchange is like a supermarket that only sells one product: the government-mandated “essential benefits” package, period. The bronze, silver, gold, and platinum labels merely indicate different copays and deductibles. The cheapest bronze plan for a family of five will cost about $20,000 (before subsidies), according to the IRS, and will cover only 60% of medical bills. Platinum plans will cover 90%.
The Obama health law empowers the Secretary of Health and Human Services for the first time in history to standardize medical care for privately insured patients. Look for thousands more regulations controlling you and your doctors.