Menu

Health Care Horizon

5 myths about health insurance under ObamaCare

As the public hears more testimony about the problems arising with ObamaCare, it's important for consumers to keep their eyes and ears open to understand whether health insurance under the Affordable Care Act will really help them, or not. Here, I debunk five myths surrounding ObamaCare so far. 

1. You can keep your plan if you like it   
The harsh reality is that, according to recent reports, more than 2 million individuals have already received notices stating that their health insurance plans will be dropping them because their benefits do not meet the current requirements of coverage.

Apparently, the White House was aware of this consequence early on in the process, even while reassurances were being provided to the public.  In retrospect, many insurance companies probably would not have supported ObamaCare if they were not given this flexibility.

Furthermore, this problem could grow worse as people struggle to enroll on Healthcare.gov - particularly if healthy individuals give up on enrolling altogether. It is possible that some insurance plans will withdraw from certain exchanges for fear of ending up with more individuals that will cost them more money because they have more health issues.

2. You can keep your doctor
While the government is not interfering in the relationship between you and your doctor, or necessarily rationing your care, there could be certain changes that could restrict access.

In particular, if the growing trend of enrollment leans towards a sicker population, then insurance companies will likely be forced to narrow the scope of their physician networks to include those hospitals and doctors they believe are the most efficient in delivering care. This is an important mechanism by which insurance companies will be able to attempt to keep prices low within the exchanges.  

The challenge for consumers enrolling through Healthcare.gov will be in their ability to make educated comparisons about which doctors are in which plans and the coverage provided by the various plan options. Those on Medicare may also experience changes in physician access if some doctors either refuse to accept Medicare because of trends in decreased reimbursement, or if the Independent Payment Advisory imposes recommendations that make it challenging for physicians to deliver care that remains profitable.      

3. Picking your new insurance plan will be easy
In order for consumers to compare plans on Healthcare.gov, they must first provide verification of their eligibility. The complexity of information that has to be shared between systems for this verification is not a new problem, and one that many insurance companies, employers and others have struggled with for years. It is likely that the glitches on Healthcare.gov will be a persistent problem.

The other significant challenge consumers will face is in interpreting the information available about the plan options, and knowing what is truly best for their needs.  This is not an easy task considering that the role of making plan recommendations has often been entrusted to some very smart consultants who have studied the industry for many years to understand the nuances of health insurance.  

It is hard to believe that everyone utilizing this site will have the wherewithal to sort through this complex information and make the right decisions – or that enough customer support will be available to fill this need .

4. My premiums will go down
The issue of whether insurance premiums will go up or down under ObamaCare really depends on individual circumstance. In general, individuals with preexisting conditions, who tend to be sicker, will likely pay less, while younger individuals who are relatively healthy will likely pay more. However, the magnitude of the rise in premiums will depend on the availability of plans in a given market and exchange, and upon one's eligibility based on income.  

If the pool of individuals enrolling continues to lean towards a sicker population, then it will be impossible for insurance companies to keep premiums low.   

Another key challenge that could delay the consumer's ability to appreciate the price benefits of ObamaCare is if the verification of eligibility for subsidies becomes complicated and the insurance companies never get the money from the government.

5. I can expect a rebate from my insurance company
Several months ago, the administration touted the rebates that were going back to individuals from insurance companies because they didn't meet the thresholds of what needed to be spent on medical care. In fact, most of the money from these 8 million rebates, of about $100 each, went back to employers who were paying for the insurance policies for their employees.  

There are expected to be about 2.5 million people on the individual market that could receive a rebate that would go directly to them, but this is yet to be seen.  While the rebate may appear to be a bonus, what consumers don't recognize is that insurance companies are, in fact, not delivering what they're supposed to which, in turn, leads to a more inefficient healthcare system and high costs.  

 It's a bit worrisome that even the experts haven't quite figured ObamaCare out, so you can imagine how difficult it will be for the average American consumer.

Dr. Sreedhar Potarazu is an acclaimed ophthalmologist and entrepreneur who has been recognized as an international visionary in the business of medicine and health information technology. He is the founder of VitalSpring Technologies Inc., a privately held enterprise software company focused on providing employers with applications to empower them to become more sophisticated purchasers of health care. Dr. Potarazu is the founder and chairman of WellZone, a social platform for driving consumer engagement in health.