As reported by Ben Conarck in the Miami Herald on February 24, 2020:
After returning to Miami last month from a work trip in China, Osmel Martinez Azcue found himself in a frightening position: he was developing flu-like symptoms, just as coronavirus was ravaging the country he had visited.
Under normal circumstances, Azcue said he would have gone to CVS for over-the-counter medicine and fought the flu on his own, but this time was different. As health officials stressed preparedness and vigilance for the respiratory illness, Azcue felt it was his responsibility to his family and his community to get tested for novel coronavirus, known as COVID-19.
He went to Jackson Memorial Hospital, where he said he was placed in a closed-off room. Nurses in protective white suits sprayed some kind of disinfectant smoke under the door before entering, Azcue said. Then hospital staff members told him he’d need a CT scan to screen for coronavirus, but Azcue said he asked for a flu test first.
“This will be out of my pocket,” Azcue, who has a very limited insurance plan, recalled saying. “Let’s start with the blood test, and if I test positive, just discharge me.” Fortunately, that’s exactly what happened. He had the flu, not the deadly virus that has infected tens of thousands of people, mostly in China, and killed at least 2,239 as of Friday’s update by the World Health Organization.
But two weeks later, Azcue got unwelcome news in the form of a notice from his insurance company about a claim for $3,270.
In 2018, President Donald Trump’s administration rolled back Affordable Care Act regulations and allowed so-called “junk plans” in the market. Consumers mistakenly assume that the plans with lower monthly costs will be better than no insurance at all in case of a medical catastrophe, but often the plans aren’t very different from going without insurance altogether.
Hospital officials at Jackson told the Miami Herald that, based on his insurance, Azcue would only be responsible for $1,400 of that bill, but Azcue said he heard from his insurer that he would also have to provide additional documentation: three years of medical records to prove that the flu he got didn’t relate to a preexisting condition …
Azcue said he earns about $55,000 a year working for a medical device company that does not offer health insurance, but his insurance plan wasn’t always so narrow. Last year, Azcue said he was covered under an Affordable Care Act-compliant plan that cost him about $278 in monthly premiums.
Those premiums shot up to $400 a month when his full year salary kicked in, so he canceled his plan in November, he said. Azcue said he now pays $180 per month for the limited plan from National General Insurance.
The limited plan’s requirement to provide three years of medical records before coverage kicks in, Corlette said, is not uncommon. The professor said she’s seen it come up for conditions like cancers that were never diagnosed but might have been hinted at in doctors’ visits from years past.
“That’s the critical difference between [Affordable Care Act] plans and junk plans,” she said. “[Junk plans] will not cover preexisting conditions.”
A spokesperson for National General Insurance did not immediately respond to a request for comment …
This is a typical example of the financial perils of Healthcare (insurance) in the United States today. It is a system still in need of extensive revision.
Healthcare – a term in evolution, which currently is used as a synonym for health insurance.
Healthcare is a socio-political construct that evolved from the older concept of health care, which had supplanted medical care, preventive medicine, and nursing care. The single-word neologism healthcare de-emphasizes the actual treatment of disease and emphasizes the political control of the eligibility process. It now means health insurance but may in the future mean single-payer socialized medicine as is now available in the advanced social democracies of Western Europe.
Somewhat a misnomer, healthcare implies the maintenance of health. On a population level, health of the collective is maintained by sanitation, potable water supplies, food safety monitoring, atmospheric depollution, waste management, mosquito and rodent control—none of which has anything to do with health insurance. On an individual level, health is maintained by exercise, a balanced diet, moderation in alcohol intake, and avoidance of stress, smoking, and sexual promiscuity, to which healthcare as health insurance gives only token support. It may pay for annual “wellness visits” which are little more than a questionnaire and a blood pressure check followed by obligatory “advice.” The bulk of health insurance payments are for prescription drugs, multilevel diagnostic testing, hospital stays, nursing care, prosthetics, orthotics, and the medical/surgical treatment of disease, not health.
Healthcare prioritizes the interests of large capitalist enterprises such as the pharmaceutical industry, health information technology, the drug benefit management industry, and the health insurance industry itself.
Obamacare – the popular term for the Patient Protection and Affordable Care Act (ACA), which resulted in the restructuring of health insurance in the United States. It was the crowning achievement of the presidency of Barack Obama and was memorialized in his name as Obamacare.
ACA, the legacy of a visionary and transformative President, was passed in 2010 through the efforts of congressional Democrats who voted unanimously for it despite unified opposition from congressional Republicans. The final bill, a tour de force of 2700 pages, demonstrated the collective expertise of healthcare planners, providers, lobbyists, and foundations. It had the support of organized medicine, academic medicine, and the health insurance, information technology, and pharmaceutical industries.
Notably, this bill protected patients from uninsurability due to preexisting illness, and termination of insurance coverage after a new illness. These provisions increased the actuarial risk to the private insurers and hence the cost to the insured. The resulting increase in premiums was partly offset by income-based federal premium subsidies and high deductibles. The high deductibles shielded the insurance industry from the need to honor lesser claims. They also gave the insured a special awareness of the cost of their care and a unique opportunity to participate directly in the payment of their health care providers.
One of the goals of Obamacare was health insurance for all the people, not just those employed by large corporations. To accomplish this, the ACA mandated that all businesses with fifty employees or more provide insurance to all employees working full time, which it defined as thirty or more hours per week. This had the unintended consequence of companies changing employees from full-time to part-time. In addition to losing health insurance coverage, many employees who depended on a full-time income to support a family had to seek a second part-time job during a period of “jobless recovery” from an ongoing recession. Many were unsuccessful and joined the ranks of the “working poor.”
For those citizens without health insurance provided by their employer, the ACA mandated that they purchase insurance privately, with a penalty/tax for non-compliance collected by the Internal Revenue Service.
Through subsidies, the ACA incentivized states to expand the enrollment and coverage of their health benefit plans for the poor, known as Medicaid. It lowered the income criteria for Medicaid eligibility to achieve inclusion of more low-income families, including the “working poor” it had helped to create.
The ACA also provided subsidies to the states to set up their own insurance brokerages, called exchanges, to service all those who would be enjoying the benefits of health insurance for the first time. Twenty-three states agreed to run these exchanges; the insurance was provided by approved private “carriers.” Most exchanges failed because of low enrollment and abandonment by the carriers who could not adapt to losing money despite the high premiums and high deductibles.
The Republicans, who opposed Obamacare at its start, called it a failure. According to President Obama and the Democrats, it was a success because it brought health care to a large population that was previously uninsured.
Note: Some observers believe that the Patient Protection and Affordable Care Act was neither protective nor affordable, and designed from the very beginning to apply a Cloward-Piven strategy to healthcare. By overwhelming the healthcare system, the anticipated failure would create a demand for a single-payer system of the kind available in Western Europe, Canada, Cuba, and Venezuela.