Friday, November 15, 2013

Obamacare woes

I feel compelled to comment on the current raging controversy about healthcare insurance. The Affordable Care Act, put forth by President Obama with good intentions to help uninsured and under-insured Americans has fundamentally stalled in roll out, given website failures & terrible PR. Insurance companies are promptly canceling some private policy holders coverage and even with the congressional "fix" voted in today, no one knows how this will play out. I fact, I believe all Americans are going to be wondering what health insurance coverage they will be left with come January 1st, 2014.

The company I work for has been quite public in their anticipation of dropping spousal coverage for full time employees and more than anxious to trim the healthcare coverage for all employees, current, as well as retirees. This billion dollar company has dropped healthcare coverage for part time employees onto the Teamster's union, thus eliminating a large cost to their bottom line. Annual changes to our health care coverage routinely occur, but at this point, the healthcare part of the union contract has not met with an approval vote nationwide, leaving lots of employees still wondering what regional healthcare coverage will be available to them next year.

I am starting to suspect the average American has a clearer grasp of how the health insurance industry works than the American government does. Our wealthy politicians most likely have never had to concern themselves with their policy coverage, nor have they spent hours on the phone fighting for justified benefits,   petitioning for coverage within their community or begging for an approval for a physician ordered specialist treatment. Most Americans realize that health insurance is vital to getting good healthcare, but also understand the punitive situation created by insurance professionals second guessing or rating medical necessity by arbitrary financial and medical parameters. These insurance determinations always take place without actually seeing the patient and are assumptions made by healthcare insurance "experts."

 I know about these situations because I have had to fight for some healthcare rights my family and I were entitled to. I know about the hoops health insurance companies use the delay resources or payments from my twenty years of experience as a nurse and having to interface with insurance representatives for hospitals, as well as patients. There are tricks to know for every insured person:  are you in or out of network?, are you using your preferred provider?, or if your vision and dental coverage are covered by a different healthcare insurer through your employee plan. Oh, and if you are married and fortunately covered under two healthcare policies; be sure to know which one is primary and have the ability to co-ordinate benefits between both insurances, because they do not talk or retrieve information from each other.

Does your head hurt yet? Mine does. This is an incredibly complex situation. The cost to the already beleaguered American public is also going to be an element which has not been adequately explained. I wonder now how England, Scandinavia or even Canada implemented their public health care systems without such hullabaloo...

1 comment:

  1. England decided to 'gift' their citizens after WWII with healthcare. After their wartime sacrifices, I believe it was well received. Canada had an initial uproar, until everyone had their first 'free' doctor visit.