With a new year dawning, most of us have our minds attuned to new chapters and fresh starts. However, January brings endings as well as beginnings, and one such ending is especially important if you or someone you know needs health insurance for 2022.
Saturday, Jan. 15, is the last day to enroll in a plan through the national Healthcare.gov website or your state insurance exchange during the regular registration period. If you miss this deadline, you will have to wait until Nov. 1 for another opportunity, unless you experience a significant life event (such as a move or the loss of a job) that qualifies you for a special enrollment.
Since its rollout in 2013 as a cornerstone of the Affordable Care Act, Healthcare.gov and its 15 affiliate state insurance exchanges have enabled millions of Americans who do not have health benefits through their jobs to access coverage for themselves and their families. Tax credits, based on household income, help to make these private plans more affordable. Some can be had for $100 or less per month. The Department of Health and Human Services estimates that 11.3 million Americans currently have health insurance through an ACA marketplace plan.
Our family’s story
My family and I count ourselves among this group. We have had insurance through the ACA marketplace(s) on two different occasions. The first was in 2014 through 2016, after the group insurance plan offered to our church’s employees through the state Baptist convention became too expensive. Our second stint began this past September, when we moved to Tennessee after five years of ministry in Canada. Without Healthcare.gov, we would rank among the 28 million Americans currently lacking any form of health insurance coverage.
We are grateful for this insurance and thankful that we have few reasons to seek medical care. That said, our coverage this time around (and the options we had to choose from) isn’t as comprehensive as it was seven years ago. If a member of our family experienced a health care emergency or received a dreaded diagnosis, we would be liable for a large percentage of our health care costs despite the monthly premiums we pay.
“If a member of our family experienced a health care emergency or received a dreaded diagnosis, we would be liable for a large percentage of our health care costs despite the monthly premiums we pay.”
A number of health services, especially those related to mental health, rehabilitation and specialized care, are not covered by our plan — or others available through our ACA marketplace. My wife’s recent ultrasound, ordered by her doctor following an inconclusive routine mammogram, still cost us $175 out-of-pocket, and she likely will need one every year going forward. Our prescription deductible is $1,500. Once we have spent that much on needed medicine, the plan will cover half the cost of each refill, which still will leave us with a combined monthly tab of more than $150, even with a GoodRx coupon.
We certainly could have it worse. But after experiencing Canada’s national health insurance system for five years, we know that we — and all Americans — certainly could have it much better, too.
The U.S. remains a global outlier
Three things continue to make U.S. health care an outlier from the rest of the developed world. First, coverage is highly inequitable. Employer-offered plans differ from company to company and division to division within corporations. Executives enjoy benefits the rank and file do not.
Even through the ACA, the number and quality of ACA marketplace plans varies from state to state and even county to county. According to a Centers for Medicare and Medicaid Services spokesperson I contacted, in the 33 Healthcare.gov states, residents of 44% of counties have three or more issuer options to weigh, while 46% have only two issuer options from which to choose. Another 10% of counties offer plans from a single issuer.
Second, many U.S. plans still do not adequately shield policy holders from detrimental out-of-pocket health care costs. The ACA establishes 10 essential health benefits that plans must cover in order to be offered on the marketplace. These standards exist to prevent insurers from offering junk plans that do not provide for basic health care needs. However, there are no clearly defined thresholds governing what it means for a plan to “cover” a benefit, so copays and coinsurance amounts for services range widely.
Three examples in Tennessee
Take, for example, the below snapshot of actual 2021 Healthcare.gov plans on offer in Tennessee, one from each of the three primary coverage levels: gold, silver and bronze.
Plan A (gold level):
- Monthly premium: $1,371 (before ACA tax credit)
- Deductible: $2,900 (family total)
- Out-of-pocket maximum: $12,600
- Generic drugs: $15
- Primary doctor visit: $15
- Specialist visit: $35
- Emergency room: 20% co-insurance after deductible
- Includes adult dental and vision
Plan B (silver level):
- Monthly premium: $1,057 (before ACA tax credit)
- Deductible: $6,000 (family total)
- Out-of-pocket maximum: $12,000
- Generic drugs: $25
- Primary doctor visit: $30
- Specialist visit: $60
- Emergency room: 40% co-insurance after deductible
- Includes child dental
Plan C (bronze level):
- Monthly premium: $847 (before ACA tax credit)
- Deductible: $16,600
- Out-of-pocket maximum: $16,600
- Generic drugs: $25
- Primary doctor visit: No charge after deductible
- Specialist visit: No charge after deductible
- Emergency room: No charge after deductible
- No dental coverage is included
At the bronze level, the tax credit available to a family with the median Tennessee household income of $54,655 would virtually if not completely offset the monthly premium for this plan. These needed subsidies make such a plan a real bargain — until you need to access health care services. The deductible for this plan is so high ($16,600) that a median-income household would have to spend 30% of their annual wages on health care before they could access many of the plan’s benefits.
‘Better than nothing’
My CMS contact assured me that bronze-level plans are offered to protect Americans from financial hardship at a low monthly cost. However, a $16,000 medical tab clearly would be a burden to a majority of Tennessee households, especially since the deductible resets every year. A lingering injury or chronic disease diagnosis under this plan could well result in financially debilitating medical bills.
“A lingering injury or chronic disease diagnosis under this plan could well result in financially debilitating medical bills.”
That possibility exists under the silver and gold plans as well. A $12,000 cap is better than a $16,000 cap; but $12,000 is still a lot of money for a lot of people. And, considering that monthly premiums are not calculated into the out-of-pocket maximum, the actual annual cost to a patient under these more expensive plans would be closer to $16,000 should their health care needs prove acute.
These numbers demonstrate that, despite its significant improvements, the ACA has done little to change the third and most dissonant feature of the American health care system: Per capita health care costs in the United States remain the highest in the developed world while health outcomes continue to lag behind most other peer countries.
U.S. life expectancy and infant mortality rates, for example, are among the worst of the 35 Organization for Economic Cooperation and Development nations, even though the U.S. outspends these other nations more than two to one.
A new study conducted by researchers from the University of Colorado and the University of Denver concludes that ACA provisions, particularly the tax credits and the elimination of exclusions for pre-existing conditions, have reduced the number of medically related bankruptcies in the U.S.
That is good news and represents a positive step forward. But the fact remains that, despite the passage of the ACA, access to health care that could save or improve lives remains cost prohibitive for far too many Americans. And our rate of medical related bankruptcies still ranks as the highest in the world. The idea that anyone would or should have to declare bankruptcy due to illness is outrageous to most other peoples of the earth. Why isn’t it outrageous here?
“Per capita health care costs in the United States remain the highest in the developed world while health outcomes continue to lag behind most other peer countries.”
Christians should lead the way
Clearly, we as a nation still have much work to do to ensure that all Americans have fair and affordable access to the first-class medicine that exists in America. Affecting change will require both a firm resolve of political will and a clear understanding of the causes underlying U.S. health care inequity.
I, for one, believe American followers of Jesus should be spearheading the effort. Those who suffer needlessly from illness, complications and treatment-related debt find themselves in the ditches that lie along the convoluted pathways of the health care system we have created and condoned, and our Lord gave us clear instructions about how we should respond to people lying in ditches (Luke 10:35-37). Let’s make heightened awareness and advocacy for health care equity one of our resolutions for 2022.
While we push for change, let’s also help others access the tools currently available. One of the surprise findings of the University of Colorado/University of Denver study is that Americans with intermittent health insurance coverage were twice as likely to file for medically related bankruptcy as the fully insured. Having health insurance, even high-deductible insurance, does make a difference — and anyone can purchase a policy (or find help enrolling in Medicaid) through Healthcare.gov.
If you or someone you know needs health insurance for 2022, be sure to visit Healthcare.gov before Jan. 15, or call (800) 318-2596. An ACA agent will be happy to assist you in finding coverage you can afford. It may not be perfect, but it’s better (much better) than nothing.
For the rest of us, let us not settle for a health care system that leaves so many physically, mentally and financially vulnerable. For the richest country on earth, better than nothing isn’t nearly good enough. We have the resources and the expertise to have a health care system that is the envy of the world. All we lack is the social and political will.
Todd Thomason
Todd Thomason is a gospel minister and justice advocate who has pastored churches in Virginia, Maryland, and Canada. He holds a doctor of ministry degree from the Candler School of Theology at Emory University and a master of divinity degree from the McAfee School of Theology at Mercer University. In addition to Baptist News Global, Todd writes regularly at viaexmachina.com. Follow him on Twitter @btoddthomason and Facebook @viaexmachina.
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