Morrison 1 Amy Morrison Tammy Frailly HUM 220 2W1 9 April 2014 Patient Protection and Affordable Care

Act !oes it Help or H"rt t#e Unins"red and Underins"red$ Many people a%oid see&in' #ealt# care e%en (#en t#ey are ill beca"se of t#e cost) *%er t#e last t#irty years #ealt#care costs #a%e risen e+ponentially and so #a%e t#e n"mber of people t#at are eit#er "nins"red or "nderins"red) ,et(een t#e years of 200- and 200. t#e n"mber of people "nins"red in t#e United /tates rose from 40)0 to 49)0 million people1 (it# an additional 20)2 million people bein' "nderins"red 2/c#oen et al) -013) W#ile "nins"red is a self4 e+planatory term1 "nderins"red re5"ires a little more e+planation) For t#e p"rposes of t#eir st"dy1 /c#oen et al) listed t#ree criteria to incl"de a person in t#e "nderins"red cate'ory 6213 o"t4of4poc&et medical e+penses for care amo"nted to 10 percent of income or more7 223 amon' lo(4income ad"lts 2belo( 200 percent of po%erty le%el31 medical e+penses amo"nted to at least 0 percent of income7 or 2-3 ded"ctibles e5"aled or e+ceeded 0 percent of income8 22993) A ded"ctible is a set amo"nt of money a person pays eac# year for medical care1 prior to t#e ins"rance be'innin' to pay t#eir portion of a person9s medical e+penses) T#ese ded"ctibles are abo%e and beyond t#e premi"ms1 or mont#ly amo"nt paid to t#e ins"rance company) *nce t#e ded"ctible is met1 t#en t#e ins"red pays eit#er a copayment1 a set amo"nt for eac# %isit to t#e doctor1 or coins"rance1 a percenta'e of t#e total bill1 i)e) 40: of t#e total bill for eac# %isit) ;n addition1 o"t of poc&et costs are t#ose medical bills t#at t#e ins"red pays directly (it# t#eir o(n

Morrison 2 money) <ac# plan 'enerally #as a ma+im"m o"t of poc&et e+pense le%el eac# year for an indi%id"al or an entire family dependin' on (#o is co%ered "nder t#e policy) *%er t#e last se%eral years t#e le%el of #ealt# care associated costs #a%e s&yroc&eted (#ile ins"rance premi"ms also rise at rates not in proportion to (a'e increases) As people are ma&in' less money in comparison to (#at t#ey are payin' o"t of poc&et for #ealt# care1 t#e needs of t#e people on t#e bottom of t#e spectr"m are bein' "nmet) T#ese indi%id"als are stri%in' to ma&e ends meet1 and are "nable to afford e%en t#e most basic #ealt# care) T#is leads to rapidly increasin' costs in t#e #ealt#care ind"stry as t#ey pass t#e cost for "nins"red and "nderins"red patients on to t#ose t#at can afford to pay t#em) Amid m"c# propa'anda and r#etoric1 t#e Patient Protection and Affordable Care Act (as si'ned into la( on Marc# 2-1 2010) President ,ara& *bama e+pressed t#at t#is bill (o"ld 6lo(er costs for families and b"siness8 26=oomin'8 23) T#is is a tall order1 and t#e American people #a%e been e+pectin' to see t#ese sa%in's become a reality) *ne of t#e initial p#ases of implementation allo(ed 6c#ildren8 to maintain #ealt# co%era'e t#ro"'# t#eir parent9s ins"rance "ntil t#ey are 2>) From 2009 to 20101 (#en t#is rolled o"t1 t#ere (as a drop in "nins"red people in t#e a'e 'ro"p of 19 ? 20 of abo"t 2)4 percenta'e points 2Cantor1 @ et al) 1.A03) T#is s#o(s an initial decline in t#e n"mber of "nins"red people partic"larly in t#is a'e 'ro"p) T#is is attrib"ted to t#e pro%ision of Patient Protection and Affordable Care Act t#at allo(s parents to maintain ins"rance on t#eir c#ildren "ntil t#ey t"rn 2> re'ardless of marital stat"s or employment) Bi%en some of t#e 'litc#es t#at occ"rred (it# t#e implementation of Healt#care Mar&etplaces startin' in *ctober 201-1 t#e p"blic is ea'erly a(aitin' n"mbers e+pressin' #o( many of t#e remainin' "nins"red people are no( co%ered) People from bot# sides of t#is iss"e #a%e ar'"ed abo"t its effecti%eness1 and #o( many people are act"ally bein' #elped by t#e

Morrison Patient Protection and Affordable Care Act) !espite t#e %ario"s claims of increased affordability and a%ailability of #ealt# care %ia t#e Patient Protection and Affordable Care Act1 t#ese plans increase o"t of poc&et costs for t#e ins"red and aren9t s"fficient to p"t e%eryone in t#e pool of people (it# #ealt# benefits e5"al to t#eir needs) ;nstead people are p"s#ed from t#e lists of "nins"red into t#e "nderins"red (it# little real benefit to t#eir #ealt#) Additionally1 d"rin' t#e open enrollment period t#ere #as not been a si'nificant decrease in t#e n"mber of "nins"red) Wit# t#e passin' of t#e Patient Protection and Affordable Care Act1 t#ere (ere n"mero"s pro%isions t#at affected t#e states1 and (ill impact costs across t#e implementation period) *ne s"c# pro%ision1 is t#e incl"sion of Medicaid e+pansion at t#e state le%el) T#is (o"ld allo( states to (iden t#e criteria to accept additional "nins"red people into t#e Medicaid pro'ram) ;nitially t#is 'ro(t# (o"ld be f"lly f"nded by t#e federal 'o%ernment1 (it# t#e state steadily incl"din' more of t#e associated costs into t#eir o(n b"d'ets o%er time) @oyce Ha#n and ,renda /#ein'old cite t#e Center on ,"d'et and Policy Priorities as e+plainin' t#at t#e federal f"ndin' starts at 100: and r"ns do(n to 90: in 2020 22>A3) T#is decline of federal f"ndin' (ill affect t#e indi%id"al ta+ payers as t#ey #a%e to come "p (it# t#e f"nds to bac&fill t#e decrease in federal money) A total of 24 states are e+pandin' t#eir Medicaid rolls1 (#ile anot#er 22 are declinin' to do so1 and fo"r states #a%e yet to ma&e a decision for or a'ainst 2Ha#n C /#ein'old 2>A3) T#ese stats s#o( t#e polarity of t#is iss"e1 and #o( t#e political ideolo'ies of t#e state 'o%ernments are affectin' t#ose t#at li%e t#ere) T#ose states t#at a'reed to t#e Medicaid e+pansions (ill #a%e to increase ta+es for t#eir constit"ents or c"t money from some(#ere else in t#e b"d'et) Con%ersely1 t#ose t#at didn9t e+pand t#eir rolls r"n t#e ris& of contin"in' to #a%e people t#at cannot afford to p"rc#ase #ealt# ins"rance)

Morrison 4 W#et#er t#e state 'o%ernments decided to e+pand or not e+pand Medicaid rolls1 t#ere are many reperc"ssions to t#eir c#oices (#ic# affect t#e affordability of ins"rance premi"ms) ;n states (#ere Medicaid #as been e+panded1 families t#at fall (it#in t#e 100: and 400: of t#e federal po%erty le%el are eli'ible to recei%e s"bsidies) Ho(e%er1 if t#e state a person resides in did not elect to e+pand t#eir Medicaid rolls1 t#en t#ey (o"ld not be eli'ible for t#ese s"bsidies) <+amples obtained %ia t#e state #ealt#care mar&etplaces s#o(ed a 'ood comparison bet(een t#e t(o models e+pansion %s) no e+pansion) *ne s"c# scenario incl"des a family of fi%e in California 2a state t#at e+panded Medicaid enrollment3 (it# an ann"al income of D1A1000 is eli'ible for MediCal) Contrari(ise1 in Eort# Carolina1 t#is same family (o"ld be ineli'ible for Medicaid) ;nstead t#eir premi"ms ran'ed from D4-4 to D90A e%ery mont#1 and t#ey didn9t 5"alify for any s"bsidies or #elp in affordin' t#ese #i'# costs) T#e premi"ms and ded"ctibles are in%ersely proportional7 as t#e premi"m c#ar'es rise1 t#e ded"ctibles and ot#er o"t of poc&et costs to t#e indi%id"al decrease) ;t9s not a matter of ma&in' ins"rance more affordable1 it9s a matter of (#en a person (ants to pay for t#e ins"rance mont#ly or (#en somet#in' catastrop#ic #appens) T#e irony of t#e sit"ation is t#at a sin'le person (it# t#e same income (as eli'ible for s"bsidies in bot# states) ;n addition to t#e f"ndin' for Medicaid e+pansion1 states t#at complied (it# t#e pro%isions to create a #ealt#care mar&etplace also #ad to ta&e on t#e cost of r"nnin' t#e mar&etplaces) W#ile t#is creates Fobs1 at least temporarily1 t#e f"nd for t#ese employees #ad to come from some(#ere) <ssentially1 more f"nds are bein' e+tracted from people in t#e form of #i'#er ta+es to pay t#ese salaries1 and s"pport t#ese (ebsites) ;n addition to state ta+ increases1 t#ere (ill also be federal ta+ increases as t#ose states t#at do e+pand t#eir rolls need f"nds from t#e federal 'o%ernment to s"pport t#e e+pansions) T#is pro'ram essentially ta&es money from

Morrison 0 one person and spreads it amon' t#ose sic&er t#an #imG#er) ;t9s not any different t#an (#at (as in place prior to t#e passin' of t#is #ealt# care reform) Eo( t#e constit"ents are F"st payin' t#e 'o%ernment to o%ersee t#e #ealt# care enrollments and 'i%in' t#em t#e opport"nity to place additional ta+ b"rdens on t#e pop"lace) W#ile t#e some states elected to #a%e state r"n mar&etplaces1 more t#an #alf of t#e states did not create mar&etplaces 2Cro(ley C Tape .A43) For t#ose states t#at didn9t elect to r"n t#eir o(n mar&etplaces1 t#e federal 'o%ernment (as t#e defa"lt c#oice) T#ey in t"rn p"t in place federally mana'ed mar&etplaces (#ere people co"ld re%ie( and enroll in plans for t#eir respecti%e state) As t#e initial mar&etplaces (ere opened in *ctober 201-1 some tec#nical diffic"lties pla'"ed t#e pro'ram) People (ere "nable to enter t#eir information1 "nable to select ins"rance plans1 and some people e%en reported an inability to si'n in) Additionally t#ese 'litc#es ca"sed people to lose fait# in t#e mar&etplaces) !espite t#ese 'litc#es1 s"r%eys from McHinsey Cons"mer Healt# ;nsi'#ts s#o( a decline from 40: to 2.: of respondents citin' tec#nical c#allen'es as a reason for not enrollin' in a #ealt#care plan on t#e mar&etplace 203) ;n essence1 people didn9t lose all confidence d"e to t#e initial problems e+#ibited t#ro"'#o"t t#e pilot p#ase) !espite people bein' (illin' to o%erloo& t#ese pro'rammin' iss"es1 t#ere (ere still "nacco"nted for costs (it# re'ards to 'ettin' t#e systems bac& online) /o1 (it# all t#ese costs1 (#ere are t#e #ealt#care sa%in's t#at t#e bill (as intended to create$ ;n 201-1 t#e Committee of <ner'y and Commerce (it#in t#e U/ Ho"se of Iepresentati%es in Con'ress p"blis#ed a report on t#eir findin's (it# re'ards to t#e anticipated costs of #ealt#care premi"ms) T#e fi'"res (ere sta''erin'1 and directly contradict t#e typical r#etoric attrib"ted to President *bama1 t#at says premi"ms for a family of fo"r (o"ld decrease appro+imately D2000 2Troy 213) Accordin' to t#e %ario"s fi'"res p"blis#ed (it#in t#e

Morrison > Con'ressional Committee9 report1 premi"ms can be e+pected to increase any(#ere from 0: "p to 140:) T#e most si'nificant increases bein' seen by people in t#e income brac&ets t#at e+ceed t#e federal po%erty le%el by 400: or more 204A3) ;ncreases are e+pected to %ary by state7 (it# t#e states t#at pre%io"sly #ad #ealt# care la(s enacted bein' on t#e smaller end of increases) ;n 'eneral1 rates are e+pected to increase across t#e board) *ne #ealt# ins"rer (as 5"oted as sayin' 6findin's s#o(ed t#at indi%id"al cons"mers in abo"t 90: of all states (o"ld li&ely face si'nificant premi"m increases8 26=oomin'8 23) As if t#e increased premi"ms (ere not eno"'#1 ded"ctibles and cost s#ares are ta&in' people from t#e "nins"red pools1 only to plop t#em firmly in t#e "nderins"red cate'ories) Accordin' to t#e Healthcare.'o% (ebsite1 a family of fi%e in Eort# Carolina (it# an income of D1A1000 ann"ally (o"ld be e+pected to pay any(#ere from D4-4 to D90A in premi"ms mont#ly) T#e t#ree c#ildren in t#is family (o"ld be eli'ible for Medicaid t#ro"'# t#e c"rrent plans) Plans in t#e D4-4 ran'e are in t#e bronJe le%el1 and #a%e a D01000 ded"ctible (it# an indi%id"al D>1-00 ann"al ma+im"m o"t of poc&et costs and D121.00 ma+im"m for a family) T#ese ma+im"m o"t of poc&et costs do not incl"de premi"ms1 so t#is is on top of t#ose fees) T#is le%el also #as t#e ins"red9s cost s#are at 40: of t#e bill after yo" pay yo"r ded"ctible) ,et(een t#e premi"ms and ded"ctibles listed #ere for t#e lo(est premi"m1 t#e ann"al o"tlay for a patient before ins"rance &ic&s in (o"ld be D1012A0) T#is represents 0.)11: of t#eir 'ross ann"al income1 and doesn9t allot for any li%in' e+penses or ta+es) <%en if t#ey co"ld afford t#is cas# o"tp"t prior to recei%in' any care1 t#ey are still responsible for 40: of any bills inc"rred after t#at) *n t#e ot#er end of t#e spectr"m lies t#e platin"m plans (#ic# re5"ire a lar'er premi"m1 b"t #a%e lo(er copayments) ;n t#e case of t#e mont#ly D90A premi"m1 t#e family (o"ld not #a%e a ded"ctible7 #o(e%er1 t#e premi"ms alone total >-)A.: of t#is family9s income) T#is

Morrison . platin"m plan is t#ro"'# ,l"e Cross ,l"e /#ield and #as a copayment of D10 for re'"lar p#ysician %isits1 as (ell as copayments for prescriptions t#at %ary based on (#et#er or not t#e dr"'s are 'eneric or brand name 2Healthcare.gov)) T#is plan is not financially feasible1 and if t#ey attempted t#e payments t#ey (o"ld most li&ely (ind "p not bein' able to pay any ot#er bills) ;n t#is sit"ation1 alt#o"'# t#e people (o"ld be off t#e rolls of t#e "nins"red1 t#is is F"st a tec#nicality) T#ey still (o"ldn9t be able to afford to act"ally 'o to t#e doctor beca"se of t#e ded"ctibles and cost s#ares) T#ey (o"ld meet t#e criteria of bein' "nderins"red) Wit#in t#ese plans are pro%isions for co%era'e t#at is a%ailable at no cost to t#e patient) For e+ample1 re5"ired pre%entati%e care is free of c#ar'e) Women co"ld 'o to t#eir doctor and recei%e a mammo'ram at no additional cost to t#emsel%es pro%ided t#ey #a%e ins"rance) =i&e(ise men co"ld #a%e prostate testin' performed and (o"ld be co%ered by t#eir policy) W#ile t#ese are 'reat pro%isions1 t#ey are not (ort# t#e o"tlay of almost 00: of a family9s income) As t#ese premi"ms are o"t of t#e ran'e of acceptability and financial feasibility1 (#at is t#e indi%id"al to do$ T#ere are penalties in%ol%ed for not p"rc#asin' ins"rance) T#ey stac& "p in s"c# a manner1 t#at many people are optin' to pay t#e penalty instead of p"rc#asin' ins"rance) T#e penalty is t#e 'reater of D90 per person or 1: of yo"r income in t#e first year and adF"sts eac# year t#r" 201> to D>90 per person or 2)0: of yo"r income7 t#ereafter t#e penalty (ill be adF"sted accordin' to cost of li%in' increases 2Harrin'ton .043) Additionally1 t#e penalty ma+es o"t at t#ree times t#e indi%id"al rate1 so t#e family of fi%e ma&in' D1A1000 (o"ld pay t#e ma+ penalty of D2A0 for 2014) Common sense (o"ld say t#at people (ill opt to pay t#e bill t#at is 14 2)0: of t#eir income %s 0A ? >4:)

Morrison A As a res"lt of t#e e+orbitant costs1 t#e n"mbers of people enrollin' in #ealt#care is minimal at best) *f t#e 00 million (it#o"t #ealt#care in 2012 26/"r%ey831 only abo"t 4)2 million #a%e enrolled %ia t#e mar&etplaces as of -G1G14 26Healt#8 -3) T#is brea&do(n doesn9t incl"de some information t#at is %ital in &no(in' (#et#er or not t#ese are all pre%io"sly "nins"red indi%id"als) W#at pool did t#ey come from$ McHinsey9s s"r%ey act"ally pro%ides some insi'#t #ere7 t#e statistics s#o( t#at appro+imately 2.: of t#e respondents (ere "nins"red pre%io"sly 26McHinsey8 -3) ;n t"rn t#is means t#at abo"t .-: of t#e people (#o responded already #ad ins"rance and F"st enrolled in ne( plans t#ro"'# t#e mar&etplaces) T#is reflects a problem in t#e reportin') Wit# less t#an 10: of t#e n"mber of "nins"red pop"lation selectin' #ealt#care t#ro"'# t#e mar&etplaces7 #o( many people are act"ally from t#e pool of "nins"red as of 2012$ T#ro"'#o"t #istory1 t#is co"ntry #as attempted to ens"re t#e needs of all are met1 (it#o"t infrin'in' "p t#ose same people9s ri'#ts) As time #as pro'ressed1 many federal pro'rams #a%e spr"n' "p "nder t#e '"ise of #elpin' t#e people) T#e Patient Protection and Affordable Care Act is not different7 t#is la( (as passed "nder t#e a"spices of ma&in' #ealt# care and ins"rance more accessible and affordable) T#e st"dies t#at #a%e been prod"ced t#"s far1 by and lar'e propose t#at t#is (ill not be t#e res"lt) Eot only are premi"ms 'oin' to increase1 b"t t#e increased ded"ctibles and copayments (ill only p"t people from t#e "nins"red cate'ory into t#e "nderins"red cate'ory) !espite its proposal for ma&in' #ealt# ins"rance more affordable and #elpin' t#ose t#at are "nins"red and "nderins"red1 t#e Patient Protection and Affordable Care Act (ill raise premi"ms and F"st s#"ffle people into a 'ro"p of ins"red9s t#at isn9t any more affordable)

Morrison 9 Wor&s Cited Cantor1 @oel C1 et al) K<arly ;mpact *f T#e Affordable Care Act *n Healt# ;ns"rance Co%era'e *f Lo"n' Ad"lts)K Health Services Research 4.)0 220123 1..-41.90) MEDLINE) Web) 2A @an) 2014) Cro(ley1 Iyan A)1 and T#omas B) Tape) KHealt# Policy ,asics Healt# ;ns"rance Mar&etplaces)K Annals of Internal Medicine 109)11 2201-3 .A44.A>) Consumer Health Com lete ! E"SC#host) Web) 01 Feb) 2014) Ha#n1 @oyce A)1 and ,renda Helen /#ein'old) KMedicaid <+pansion T#e !ynamic Healt# Care Policy =andscape)K Nursing Economic$ -1)> 2201-3 2>.429.) Academic Search Com lete) Web) 1A Feb) 2014) Harrin'ton1 /cott <) KU)/) Healt#4Care Ieform T#e Patient Protection and Affordable Care Act)K %ournal of Ris& ' Insurance ..)- 220103 .0-4.0A) "usiness Source Com lete) Web) 2A @an) 2014) Healthcare.gov) 2014) Web Accessed -1 Mar) 2014) 6Healt# ;ns"rance Mar&etplace Marc# <nrollment Ieport)8 De artment of Health and Human Services. 11 Mar) 2014) Web) Accessed 20 Mar 2014) 6T#e =oomin' Premi"m Iate /#oc&)8 (S House of Re resentatives Committee #n Energ) and Commerce. C#airman Fred Upton) 1- May 201-) Web) Accessed 14 Febr"ary 2014) 6McHinsey Center for U)/) Healt# /ystem Ieform4;ndi%id"al Mar&et <nrollment Updated Mie()8 Mc*inse) ' Com an)) 0> Mar) 2014) Web Accessed 20 Marc# 2014) /c#oen1 Cat#y1 et al) KHo( Many Are Underins"red$ Trends Amon' U)/) Ad"lts1 200- and 200.)K Health Affairs 2.) 2200A3 (29A4(-09) Academic Search Com lete) Web) 01 Feb) 2014)

Morrison 10 K/"r%ey A4 Million Unins"red or Underins"red ;n ;n 2012)K Health Care Collector+ ,he Monthl) Ne-sletter for Health Care Collectors 2.)1 2201-3 -40) "usiness Source Com lete) Web) 10 Feb) 2014) Troy1 Te%i) KT#e T#ree Failed Promises of *bamacare)K Commentar) 1->)0 2201-3 2042-) Academic Search Com lete) Web) 2A Mar) 2014)