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Friday, November 15, 2013 - Page updated at 09:03 p.m.
Guest: If you like your health plan can you keep it under Affordable Care Act?
By Mike Kreidler
Special to The Times
NOW that insurers are sending cancellation notices to people who buy their own health insurance, much has been made of President Obama’s 2009 statement, “If you like your plan, you’ll be able to keep it.”
We estimate that about 290,000 people in Washington state have received a notice and will have to pick a new plan by Jan. 1.
What the president said about the Affordable Care Act is true for about 95 percent of people with health insurance, according to his administration’s estimate. That is because they already have good coverage from their employer, Medicare, Medicaid or Tricare.
The people receiving cancellation notices are those who buy their own health insurance. And nothing about these notices is new.
Health insurers have been canceling and replacing individual policies for years. They have also slashed benefits, raised deductibles and charged more. Until now, unless those buying individual policies could pass a lengthy questionnaire probing previous health issues, many stayed with their plan, regardless of the changes, because they had no other options.
Most individual health-insurance plans in our state did not cover prescription drugs or maternity benefits. They also had typical out-of-pocket costs of $10,000 to $15,000. I can tell you firsthand that a lot of people had coverage they could never afford to use.
Every time a rate change came through, they would call my office asking what they could do. Many kept their bare-bones coverage, believing it would protect themselves and their families in case the worst happened.
But what happens if you get cancer or develop multiple sclerosis and you have no prescription drug coverage?
The leading cause of bankruptcy in our country is medical debt. Yes, some of that is driven by people without coverage, but it is also driven by people with inadequate coverage.
Now, under the Affordable Care Act, all health plans must provide at least a minimum level of meaningful coverage. Most of us already have plans that provide good coverage. They do not deny you if you are sick, cover at least the 10 essential health benefits — including prescription drugs and maternity care — and they limit your out-of-pocket costs. Individual health plans must now meet these same basic standards.
I have heard from some people who liked the health plan they had. Many have said they will not qualify for subsidies, and they have no need for prescription drugs or maternity coverage. The new benefit requirements will not please everyone. But insurance does not work if you buy it only when you need it.
Take maternity care, for example. If you bought maternity coverage only when you needed it, no one could afford it. Insurance works best when all of us — young and old, healthy and sick — bear the risks.
Start stripping out benefits — no maternity care for younger people, no coverage for hip replacements for seniors, no prescription drugs, no hospital payments — and soon we are right back to where we were before health reform. No meaningful coverage for people when they really need it, and the rest of us with insurance picking up the costs.
The goal of the Affordable Care Act is to give everyone access to meaningful, quality health insurance. Most of us have had good coverage for years. Guaranteeing the same benefits for everyone is the first step to fixing what ails our health-care system.
Let’s not lose sight of what we are finally trying to accomplish: a healthier population for years to come.
Mike Kreidler is insurance commissioner for Washington state.
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